Provider Demographics
NPI:1952677882
Name:DUVALL, CLYDE JEFFERSON JR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:JEFFERSON
Last Name:DUVALL
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4647
Mailing Address - Country:US
Mailing Address - Phone:828-883-3132
Mailing Address - Fax:828-884-4283
Practice Address - Street 1:371 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4647
Practice Address - Country:US
Practice Address - Phone:828-883-3132
Practice Address - Fax:828-884-4283
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist