1578870614 NPI number — DR. HILLARY LEIGH DUVIVIER PHARMD

Table of content: DR. HILLARY LEIGH DUVIVIER PHARMD (NPI 1578870614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578870614 NPI number — DR. HILLARY LEIGH DUVIVIER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUVIVIER
Provider First Name:
HILLARY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOLSTEADT
Provider Other First Name:
HILLARY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578870614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3069 VIRGINIA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-207-6477
Provider Business Mailing Address Fax Number:
928-338-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KROME SERVICE PROCESSING CENTER
Provider Second Line Business Practice Location Address:
18201 SW 12TH STREET
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-207-2001
Provider Business Practice Location Address Fax Number:
928-338-3510
Provider Enumeration Date:
09/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  S018114 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57709751 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".