Provider Demographics
NPI:1659829950
Name:BASTUG, ALYSSA DAVIS (PHARMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:DAVIS
Last Name:BASTUG
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1661
Mailing Address - Country:US
Mailing Address - Phone:804-253-0351
Mailing Address - Fax:
Practice Address - Street 1:7045 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1661
Practice Address - Country:US
Practice Address - Phone:804-253-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264811835P1200X
SC368201835P1200X
VA02022157221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy