Provider Demographics
NPI:1629669197
Name:DUQUE, MARILYN (RPH)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DUQUE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 SW 82ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5446
Mailing Address - Country:US
Mailing Address - Phone:786-282-4279
Mailing Address - Fax:
Practice Address - Street 1:4620 SW 82ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5446
Practice Address - Country:US
Practice Address - Phone:786-282-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist