Provider Demographics
NPI:1760652598
Name:PURVIS, TARA LEIGH (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:PURVIS
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 1:1000 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2597
Mailing Address - Country:US
Mailing Address - Phone:775-786-7200
Mailing Address - Fax:775-328-1838
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-786-7200
Practice Address - Fax:775-328-1838
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080101891835P0018X
FLPS425581835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric