Provider Demographics
NPI:1669519419
Name:DUCA, ROBERT A JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:DUCA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17224 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3308
Mailing Address - Country:US
Mailing Address - Phone:718-463-5590
Mailing Address - Fax:
Practice Address - Street 1:17224 46TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3308
Practice Address - Country:US
Practice Address - Phone:718-463-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00856919Medicaid
NY00856919Medicaid