Provider Demographics
NPI:1326739574
Name:DUVERT, MARIE MAGGIE (RPH)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MAGGIE
Last Name:DUVERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 BARTOW RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6585
Mailing Address - Country:US
Mailing Address - Phone:863-686-5161
Mailing Address - Fax:
Practice Address - Street 1:1635 BARTOW RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6585
Practice Address - Country:US
Practice Address - Phone:863-686-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist