Individual
TRAVIS JAY FREEZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
1 CHOCTAW WAY, TALIHINA, OK 74571-2022
(918) 567-7000
Mailing address
22599 BLUE BIRD LN, POTEAU, OK 74953-8647
(918) 567-7000
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13609
OK
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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