Provider Demographics
NPI:1053551895
Name:KEMP, TRAVIS MICHAEL (RPHD)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:KEMP
Suffix:
Gender:M
Credentials:RPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5TH AVE. & ROOSEVELT RD.
Mailing Address - Street 2:BLDG 37
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5221
Mailing Address - Country:US
Mailing Address - Phone:708-473-6206
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE. & ROOSEVELT RD.
Practice Address - Street 2:BLDG 37
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5221
Practice Address - Country:US
Practice Address - Phone:708-473-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist