Active NPI
Travis Gannon
- Pharmacist
- Shelby Township, MI
National Provider Identifier
1225632599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302412978
- Practice address
- 8200 26 Mile Rd
Shelby Township, MI 48316-5132 - Phone
- (586) 677-5084
- NPI assigned
- Nov 26, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 5302412978 | MI | Primary |
Addresses
Primary practice location
8200 26 Mile Rd
Shelby Township, MI 48316-5132
Mailing address
17433 Duval CT
Clinton Township, MI 48038-7127
Phone (586) 353-1151
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302412978 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606348800000",
"number": "1225632599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17433 DUVAL CT",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480387127",
"telephone_number": "586-353-1151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 26 MILE RD",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483165132",
"telephone_number": "586-677-5084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "TRAVIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-26",
"last_updated": "2020-11-26",
"certification_date": "2020-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302412978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.