Healthcare Provider Details

I. General information

NPI: 1477593101
Provider Name (Legal Business Name): JENIFER CORINNE DUVALL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CENTRAL CAMPUS DR ROOM 156
SALT LAKE CITY UT
84112-9149
US

IV. Provider business mailing address

200 S CENTRAL CAMPUS DR ROOM 156
SALT LAKE CITY UT
84112-9149
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3363
  • Fax: 801-587-3375
Mailing address:
  • Phone: 801-587-3363
  • Fax: 801-587-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5039649-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: