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General NPI Number Information
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NPI Number | 1912509530
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Entity Type | Individual
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Provider Name | MATTHEW B PURVIS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 1002 W BEACON ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3204
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Country | US
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Telephone | 601-656-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 15552 HIGHWAY 503
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City | DECATUR
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State | MS
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Zip | 39327-9686
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Country | US
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Telephone | 662-816-8756
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Fax |
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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 | E-14378
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License Number State | MS
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