Provider Demographics
NPI:1659245488
Name:DUCLOS, DEAN
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:DUCLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VALLEY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2074
Mailing Address - Country:US
Mailing Address - Phone:888-822-7428
Mailing Address - Fax:201-475-9633
Practice Address - Street 1:1401 VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2074
Practice Address - Country:US
Practice Address - Phone:888-822-7428
Practice Address - Fax:201-475-9633
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02446200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist