Provider Demographics
NPI:1790259174
Name:CHARLES, DUCLAS MESMIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUCLAS
Middle Name:MESMIN
Last Name:CHARLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2308
Mailing Address - Country:US
Mailing Address - Phone:917-402-1185
Mailing Address - Fax:
Practice Address - Street 1:113 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7243
Practice Address - Country:US
Practice Address - Phone:212-675-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013136183500000X
NJ28RI03766100183500000X
NYI061289-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist