Provider Demographics
NPI:1285958975
Name:DUNN, TRAVIS MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MARK
Last Name:DUNN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MCCANN RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4541
Mailing Address - Country:US
Mailing Address - Phone:903-758-0024
Mailing Address - Fax:903-758-0678
Practice Address - Street 1:1100 MCCANN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4541
Practice Address - Country:US
Practice Address - Phone:903-758-0024
Practice Address - Fax:903-758-0678
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist