Provider Demographics
NPI:1912509530
Name:PURVIS, MATTHEW B (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:PURVIS
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 1:15552 HIGHWAY 503
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-9686
Mailing Address - Country:US
Mailing Address - Phone:662-816-8756
Mailing Address - Fax:
Practice Address - Street 1:1002 W BEACON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3204
Practice Address - Country:US
Practice Address - Phone:601-656-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist