Provider Demographics
NPI:1194360032
Name:DUPLJAK, AJLA
Entity Type:Individual
Prefix:
First Name:AJLA
Middle Name:
Last Name:DUPLJAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILLIAM ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2816
Mailing Address - Country:US
Mailing Address - Phone:646-664-5064
Mailing Address - Fax:
Practice Address - Street 1:3216 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4201
Practice Address - Country:US
Practice Address - Phone:347-862-4464
Practice Address - Fax:347-862-4465
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0645691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist