Provider Demographics
NPI:1114764339
Name:PURNELL, JAZLYN KIANA (PHARMD)
Entity type:Individual
Prefix:
First Name:JAZLYN
Middle Name:KIANA
Last Name:PURNELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N PLANTATION AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5654
Mailing Address - Country:US
Mailing Address - Phone:479-595-3828
Mailing Address - Fax:
Practice Address - Street 1:1274 N COLORADO DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6505
Practice Address - Country:US
Practice Address - Phone:479-251-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD17047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist