Provider Demographics
NPI:1174055818
Name:DUKES, CAROL TERESA
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:TERESA
Last Name:DUKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:TERESA
Other - Last Name:MONCHOIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:224 HIGHLAND BLVD
Mailing Address - Street 2:APT. 808
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1949
Mailing Address - Country:US
Mailing Address - Phone:347-603-5290
Mailing Address - Fax:712-312-1048
Practice Address - Street 1:420 MOTHER GASTON BLVD
Practice Address - Street 2:C/O MED-RX PHARMACY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7618
Practice Address - Country:US
Practice Address - Phone:718-312-1048
Practice Address - Fax:718-312-1049
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist