Provider Demographics
NPI:1124374681
Name:PURVIS, DANIEL BLAKE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BLAKE
Last Name:PURVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2657
Mailing Address - Country:US
Mailing Address - Phone:229-896-2300
Mailing Address - Fax:229-896-1350
Practice Address - Street 1:715 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2657
Practice Address - Country:US
Practice Address - Phone:229-896-2300
Practice Address - Fax:229-896-1350
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist