Provider Demographics
NPI:1679099683
Name:PURSLEY, STUART TRAVIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:TRAVIS
Last Name:PURSLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 CREEKWOOD DR APT 18
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6533
Mailing Address - Country:US
Mailing Address - Phone:270-498-1085
Mailing Address - Fax:
Practice Address - Street 1:501 MARSAILLES RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1911
Practice Address - Country:US
Practice Address - Phone:859-873-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist