Provider Demographics
NPI:1225308364
Name:DUCEPT, ROSS (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:DUCEPT
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2304
Mailing Address - Country:US
Mailing Address - Phone:651-455-5590
Mailing Address - Fax:651-455-3362
Practice Address - Street 1:1133 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-2304
Practice Address - Country:US
Practice Address - Phone:651-455-5590
Practice Address - Fax:651-455-3362
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist