Provider Demographics
NPI:1750020905
Name:POWELL, TRAVIA
Entity Type:Individual
Prefix:
First Name:TRAVIA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25602 INTERSTATE 45 STE 108
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1350
Mailing Address - Country:US
Mailing Address - Phone:832-326-0161
Mailing Address - Fax:
Practice Address - Street 1:25602 INTERSTATE 45 STE 108
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77386-1350
Practice Address - Country:US
Practice Address - Phone:832-326-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician