Provider Demographics
NPI:1063619955
Name:DUVALL, KEVIN RONALD (RPH, CDE)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RONALD
Last Name:DUVALL
Suffix:
Gender:M
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 SUGARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7037
Mailing Address - Country:US
Mailing Address - Phone:614-855-5297
Mailing Address - Fax:
Practice Address - Street 1:553 HEBRON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43056-1402
Practice Address - Country:US
Practice Address - Phone:740-522-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-26036183500000X
GARPH020951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist