Provider Demographics
NPI:1063410223
Name:DUVALL ENTERPRISES INC
Entity type:Organization
Organization Name:DUVALL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:LEE PASCHAL
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:479-229-4040
Mailing Address - Street 1:P O 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:479-229-4049
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:479-229-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
ARAR02329333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191167407Medicaid
AR191167407Medicaid