Provider Demographics
NPI:1922037878
Name:DUVALS PHARMACY INC
Entity Type:Organization
Organization Name:DUVALS PHARMACY INC
Other - Org Name:DUVALS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:781-447-0606
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-0429
Mailing Address - Country:US
Mailing Address - Phone:781-447-0606
Mailing Address - Fax:781-447-4769
Practice Address - Street 1:571 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1337
Practice Address - Country:US
Practice Address - Phone:781-447-0606
Practice Address - Fax:781-447-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MADS149423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020708BMedicaid
2039759OtherPK
2039759OtherPK