Provider Demographics
NPI:1629052048
Name:ABBOTT, DEAN J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:J
Last Name:ABBOTT
Suffix:
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 1:21 VICTORY RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3717
Mailing Address - Country:US
Mailing Address - Phone:845-357-8646
Mailing Address - Fax:845-357-8646
Practice Address - Street 1:21 VICTORY RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3717
Practice Address - Country:US
Practice Address - Phone:845-357-8646
Practice Address - Fax:845-357-8646
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039852183500000X
NJ28R102328500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist