Provider Demographics
NPI:1316097058
Name:TRAVIS, CHARLES J (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:TRAVIS
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 1:1055 RTE 202 N
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3936
Mailing Address - Country:US
Mailing Address - Phone:908-429-5544
Mailing Address - Fax:908-429-1345
Practice Address - Street 1:1055 RTE 202 N
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3936
Practice Address - Country:US
Practice Address - Phone:908-429-5544
Practice Address - Fax:908-429-1345
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02353600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist