Healthcare Provider Details

I. General information

NPI: 1578870614
Provider Name (Legal Business Name): HILLARY LEIGH DUVIVIER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILLARY LEIGH VOLSTEADT PHARMD

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KROME SERVICE PROCESSING CENTER 18201 SW 12TH STREET
MIAMI FL
33194
US

IV. Provider business mailing address

3069 VIRGINIA STREET
MIAMI FL
33133
US

V. Phone/Fax

Practice location:
  • Phone: 305-207-2001
  • Fax: 928-338-3510
Mailing address:
  • Phone: 928-207-6477
  • Fax: 928-338-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: