Provider Demographics
NPI:1790864338
Name:PURVIS PHARMACIES PC
Entity Type:Organization
Organization Name:PURVIS PHARMACIES PC
Other - Org Name:HUFF'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-635-7931
Mailing Address - Street 1:136 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3713
Mailing Address - Country:US
Mailing Address - Phone:706-635-7931
Mailing Address - Fax:706-635-4334
Practice Address - Street 1:136 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3713
Practice Address - Country:US
Practice Address - Phone:706-635-7931
Practice Address - Fax:706-635-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GAPHRE0094183336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016215OtherPK
GA514229068BMedicaid
GA514229068AMedicaid
GA514229068AMedicaid
6051900001Medicare NSC
GA514229068BMedicaid
511G730010Medicare PIN