Provider Demographics
NPI:1336802065
Name:BRAATZ, TRAVIS RICHARD
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:RICHARD
Last Name:BRAATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SOPHRIRA LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6543
Mailing Address - Country:US
Mailing Address - Phone:814-946-4267
Mailing Address - Fax:814-946-5324
Practice Address - Street 1:181 SOPHRIRA LN
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6543
Practice Address - Country:US
Practice Address - Phone:814-946-4267
Practice Address - Fax:814-946-5324
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046212L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist