Provider Demographics
NPI:1760817167
Name:DUKE PHARMACY LLC
Entity Type:Organization
Organization Name:DUKE PHARMACY LLC
Other - Org Name:MEDS DIRECT RX OF NV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER, AO
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-888-8099
Mailing Address - Street 1:5710 LBJ FWY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6324
Mailing Address - Country:US
Mailing Address - Phone:214-888-8099
Mailing Address - Fax:214-261-2217
Practice Address - Street 1:61 SPECTRUM BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4838
Practice Address - Country:US
Practice Address - Phone:702-922-1899
Practice Address - Fax:877-253-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NVPHC028983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157347OtherPK