Provider Demographics
NPI:1972954550
Name:NASH, PURVIS GLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:PURVIS
Middle Name:GLEN
Last Name:NASH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-0545
Mailing Address - Country:US
Mailing Address - Phone:318-237-5781
Mailing Address - Fax:
Practice Address - Street 1:700 HOLLEY DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-3021
Practice Address - Country:US
Practice Address - Phone:318-237-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist