MEDICARE: ALYSSA WASSUM PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202213341	VA

General Provider Information

NPI Number	:	1356946990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA WASSUM PHARM D

Provider Business Mailing Address
First Line	:	6400 CENTRALIA RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6523
Country	:	US
Telephone Number	:	804-796-9084
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 CENTRALIA RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6523
Country	:	US
Telephone Number	:	804-796-9084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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Directions to “ ALYSSA WASSUM PHARM D” Practice Location

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