Provider Demographics
NPI:1851752489
Name:TRAVIS, ELIZABETH BARRETT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BARRETT
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3366
Mailing Address - Country:US
Mailing Address - Phone:508-588-6800
Mailing Address - Fax:508-588-6866
Practice Address - Street 1:720 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3366
Practice Address - Country:US
Practice Address - Phone:508-588-6800
Practice Address - Fax:508-588-6866
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist