Provider Demographics
NPI:1659047868
Name:LUMSDEN, TRAVONE JEMALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVONE
Middle Name:JEMALL
Last Name:LUMSDEN
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 1:202 WADE LN UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7395
Mailing Address - Country:US
Mailing Address - Phone:336-207-3595
Mailing Address - Fax:
Practice Address - Street 1:2110 BELLS HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-6978
Practice Address - Country:US
Practice Address - Phone:843-539-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist