Provider Demographics
NPI:1386253623
Name:ROBERTSON, TRAVIS SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:SCOTT
Last Name:ROBERTSON
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 1:1000 ISLAND POINT DR APT 1110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5655
Mailing Address - Country:US
Mailing Address - Phone:954-646-4626
Mailing Address - Fax:
Practice Address - Street 1:463855 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3639
Practice Address - Country:US
Practice Address - Phone:904-261-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNONE
NAOtherNA