Healthcare Provider Details

I. General information

NPI: 1194659219
Provider Name (Legal Business Name): TRAVIS BASSELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 10TH ST NW APT 217
CHARLOTTESVILLE VA
22903-2255
US

IV. Provider business mailing address

400 10TH ST NW APT 217
CHARLOTTESVILLE VA
22903-2255
US

V. Phone/Fax

Practice location:
  • Phone: 770-815-2405
  • Fax:
Mailing address:
  • Phone: 770-815-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223510
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: