Provider Demographics
NPI:1982010153
Name:TRAVIS, MELINDA (RPH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W A ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3954
Mailing Address - Country:US
Mailing Address - Phone:828-466-1500
Mailing Address - Fax:828-466-1500
Practice Address - Street 1:401 W A ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3954
Practice Address - Country:US
Practice Address - Phone:828-466-1500
Practice Address - Fax:828-466-1500
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10981183500000X
AK1128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist