Provider Demographics
NPI:1801426861
Name:KNEBEL, TRAVIS JOSEPH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JOSEPH
Last Name:KNEBEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 SIERRA VISTA PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2040
Mailing Address - Country:US
Mailing Address - Phone:314-355-8314
Mailing Address - Fax:
Practice Address - Street 1:1589 SIERRA VISTA PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2040
Practice Address - Country:US
Practice Address - Phone:314-355-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist