Healthcare Provider Details

I. General information

NPI: 1386965960
Provider Name (Legal Business Name): REINALDO CHARLES DUVAL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

1301 KS HIGHWAY 264 RM 202
LARNED KS
67550-5353
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-7003
  • Fax:
Mailing address:
  • Phone: 620-285-4155
  • Fax: 620-285-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS47529
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number1-15290
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS47529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: