Priscilla Bolt Travis, DPH
Individual provider Active NPI Pharmacist · Lavergne, TN
NPI 1508164997 · NPPES record last updated Mar 9, 2011
Key facts
- NPI
- 1508164997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5831 (TN)
- Practice address
- 5192 Murfreesboro Road
Rite Aid Pharmacy
Lavergne, TN 37086 - Phone
- (615) 213-2222
- NPI assigned
- Mar 9, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5831 | TN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5831 | TN | Yes |
Addresses
Primary practice location
5192 Murfreesboro Road
Rite Aid Pharmacy
Lavergne, TN 37086
Mailing address
956 Everett Dr
Smyrna, TN 37167-6217
Phone (615) 459-3925
Other providers in Lavergne, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.