Provider Demographics
NPI:1770911364
Name:MCILVAIN, DUANN (PHARMD)
Entity type:Individual
Prefix:
First Name:DUANN
Middle Name:
Last Name:MCILVAIN
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 1:4720 W PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3633
Mailing Address - Country:US
Mailing Address - Phone:623-748-3556
Mailing Address - Fax:
Practice Address - Street 1:4720 W PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3633
Practice Address - Country:US
Practice Address - Phone:623-748-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016532183500000X
OK12722183500000X
TX39165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist