Individual
RUSSELL TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1177 WAVERLY DR, ALBANY, OR 97321
(541) 967-6448
Mailing address
22646 PAMPLICO DR, SANTA CLARITA, CA 91350
(310) 612-8066
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
1807
AK
183500000X
Pharmacist
39414
CA
183500000X
Pharmacist
Primary
7463
OR
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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