Provider Demographics
NPI:1356542039
Name:STALLBAUMER, TRAVIS EUGENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:EUGENE
Last Name:STALLBAUMER
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 1:1113 RIVER BLUFFS RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-2636
Mailing Address - Country:US
Mailing Address - Phone:785-548-5371
Mailing Address - Fax:
Practice Address - Street 1:1600 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-9739
Practice Address - Country:US
Practice Address - Phone:785-336-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS13515OtherPHARMACY LICENSE NUMBER