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General NPI Number Information
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NPI Number | 1780770222
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Entity Type | Individual
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Provider Name | FRED EUGENE PURVIS GA RPH 10245
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WINN DIXIE 101 103 TALMADGE DR
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City | MOULTRIE
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State | GA
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Zip | 31768
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Country | US
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Telephone | 229-891-2555
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Fax | 229-890-9826
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Provider Business Mailing Address
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Address Line | 163 HWY 37
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City | ADEL
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State | GA
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Zip | 31620
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Country | US
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Telephone | 229-896-2637
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Fax | 229-896-1302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | GARPH10295
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License Number State | GA
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