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General NPI Number Information
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NPI Number | 1790259174
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Entity Type | Individual
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Provider Name | DUCLAS MESMIN CHARLES PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 113 W 25TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-7243
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Country | US
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Telephone | 212-675-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1291 E 52ND ST
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City | BROOKLYN
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State | NY
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Zip | 11234-2308
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Country | US
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Telephone | 917-402-1185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0013136
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03766100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | I061289-1
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License Number State | NY
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