Provider Demographics
NPI:1255931614
Name:ALLISON, TRAVIS (PHARMD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ALLISON
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 1:4217 SWISS AVE APT 353
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6685
Mailing Address - Country:US
Mailing Address - Phone:806-654-7441
Mailing Address - Fax:
Practice Address - Street 1:720 W PIPELINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4928
Practice Address - Country:US
Practice Address - Phone:817-799-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist