Provider Demographics
NPI:1477593101
Name:DUVALL, JENIFER CORINNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:CORINNE
Last Name:DUVALL
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 1:200 S CENTRAL CAMPUS DR
Mailing Address - Street 2:ROOM 156
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-9149
Mailing Address - Country:US
Mailing Address - Phone:801-587-3363
Mailing Address - Fax:801-587-3375
Practice Address - Street 1:200 S CENTRAL CAMPUS DR
Practice Address - Street 2:ROOM 156
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9149
Practice Address - Country:US
Practice Address - Phone:801-587-3363
Practice Address - Fax:801-587-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5039649-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist