Provider Demographics
NPI:1104809441
Name:OLIVER, TRAVIS BRYAN (PHARMACIST PHARM D)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:BRYAN
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PHARMACIST PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1921
Mailing Address - Country:US
Mailing Address - Phone:864-877-0753
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1921
Practice Address - Country:US
Practice Address - Phone:864-877-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011237183500000X
NC22941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist