Provider Demographics
NPI:1194324905
Name:TRAVIS-KUEBLER, MARY SALOME (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SALOME
Last Name:TRAVIS-KUEBLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14060 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5502
Mailing Address - Country:US
Mailing Address - Phone:281-516-2486
Mailing Address - Fax:
Practice Address - Street 1:14060 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5502
Practice Address - Country:US
Practice Address - Phone:281-516-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist