Provider Demographics
NPI:1124533377
Name:SNOW, TRAVIS (PHARMD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SNOW
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 1:1100 CANYON VIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5672
Mailing Address - Country:US
Mailing Address - Phone:435-703-9680
Mailing Address - Fax:
Practice Address - Street 1:1100 CANYON VIEW DR STE C
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5672
Practice Address - Country:US
Practice Address - Phone:435-703-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7066416-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist