Provider Demographics
NPI:1780783175
Name:COLCOL, WILHELMINA DUQUE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:DUQUE
Last Name:COLCOL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FOSTORIA ST
Mailing Address - Street 2:APT. 22
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-1707
Mailing Address - Country:US
Mailing Address - Phone:845-446-5763
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:PHARMACY SERVICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045958-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist