Provider Demographics
NPI:1801128145
Name:TRAVERS, GREGORY EDWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWARD
Last Name:TRAVERS
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 1:110 ARCH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2164
Mailing Address - Country:US
Mailing Address - Phone:518-366-1437
Mailing Address - Fax:
Practice Address - Street 1:521 DUANESBURG RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-1054
Practice Address - Country:US
Practice Address - Phone:518-355-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053983-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist