Provider Demographics
NPI:1821731563
Name:CLEFFMAN, TRAVIS LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LYNN
Last Name:CLEFFMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 E 610TH AVE
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:KS
Mailing Address - Zip Code:66756-4083
Mailing Address - Country:US
Mailing Address - Phone:620-249-8357
Mailing Address - Fax:
Practice Address - Street 1:1195 E 610TH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:KS
Practice Address - Zip Code:66756-4083
Practice Address - Country:US
Practice Address - Phone:620-249-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18725183500000X
MO2020005564183500000X
KS1-109709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist