Provider Demographics
NPI:1063415743
Name:WATTS, TRAVIS EDWARD (PHARMD, CDE, BCPS)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:EDWARD
Last Name:WATTS
Suffix:
Gender:M
Credentials:PHARMD, CDE, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OUTABOUNDS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3079
Mailing Address - Country:US
Mailing Address - Phone:405-285-8766
Mailing Address - Fax:405-951-3916
Practice Address - Street 1:3625 NW 56TH ST
Practice Address - Street 2:5 CORPORATE PLAZA
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4519
Practice Address - Country:US
Practice Address - Phone:405-951-3829
Practice Address - Fax:405-951-3916
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK114931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
20510562OtherCDE
3024935OtherBCPS CREDENTIAL
OK11493OtherPHARMACY LISCENSE