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Individual

JACQUELYN RENAE TRAVERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
120 N BRYANT AVE, EDMOND, OK 73034-6302
(405) 341-8490
Mailing address
508 SPARROW HAWK DR, EDMOND, OK 73003
(405) 216-9612

Taxonomy

Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
14727
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
164525
NABP
OK
Enumeration date
01/13/2012
Last updated
01/13/2012
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