Provider Demographics
NPI:1720420524
Name:TARVIN, VERLENCIA JORDAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:VERLENCIA
Middle Name:JORDAN
Last Name:TARVIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:VERLENCIA
Other - Middle Name:DANIELLE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2400 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4555
Mailing Address - Country:US
Mailing Address - Phone:318-267-3001
Mailing Address - Fax:
Practice Address - Street 1:2400 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4555
Practice Address - Country:US
Practice Address - Phone:318-267-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist