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NPI Code Detail

MEDICARE: VERLENCIA JORDAN TARVIN PHARM. D.

MEDICARE: VERLENCIA JORDAN TARVIN 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
1183500000XPharmacist020183LA

General Provider Information

NPI Number : 1720420524
Entity Type Code : Individual
Provider Name (Legal Business Name) : VERLENCIA JORDAN TARVIN PHARM. D.
Provider Business Mailing Address
First Line : 2400 CYPRESS ST
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-4555
Country : US
Telephone Number : 318-267-3001
Fax Number :
Provider Business Practice Location Address
First Line : 2400 CYPRESS ST
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-4555
Country : US
Telephone Number : 318-267-3001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2013
Last Update Date : 09/22/2022

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