Provider Demographics
NPI:1154917268
Name:DUVALL, MARSHA (PD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:DUVALL
Suffix:
Gender:F
Credentials:PD
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 240
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-0240
Mailing Address - Country:US
Mailing Address - Phone:479-229-4040
Mailing Address - Fax:
Practice Address - Street 1:1176 STATE HIGHWAY 22 W STE A
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3006
Practice Address - Country:US
Practice Address - Phone:479-229-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist