Provider Demographics
NPI:1659045482
Name:DUVALL, CHANELLE L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHANELLE
Middle Name:L
Last Name:DUVALL
Suffix:
Gender:F
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:CO
Mailing Address - Zip Code:81036-0010
Mailing Address - Country:US
Mailing Address - Phone:719-438-5832
Mailing Address - Fax:
Practice Address - Street 1:1201 MAINE ST
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:CO
Practice Address - Zip Code:81036-9900
Practice Address - Country:US
Practice Address - Phone:719-438-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist