Active NPI
Travis C Jackman, PHARM D
- Pharmacist
- St George, UT
National Provider Identifier
1144595968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4911172-1701
- Practice address
- 617 E Riverside Dr Ste 104
St George, UT 84790-8720 - Phone
- (435) 656-2059
- Fax
- (435) 656-3059
- NPI assigned
- Mar 12, 2012
- Last updated
- Dec 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4911172-1701 | UT | Primary |
Addresses
Primary practice location
617 E Riverside Dr Ste 104
St George, UT 84790-8720
Mailing address
1508 Boys Pond Cir
Santa Clara, UT 84765-5736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4911172-1701 | UT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fusion Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608163200000",
"number": "1144595968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 BOYS POND CIR",
"city": "SANTA CLARA",
"state": "UT",
"postal_code": "847655736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 E RIVERSIDE DR STE 104",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847908720",
"telephone_number": "435-656-2059",
"fax_number": "435-656-3059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKMAN",
"first_name": "TRAVIS",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-12",
"last_updated": "2020-12-17",
"certification_date": "2020-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "4911172-1701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.