Provider Demographics
NPI:1912274754
Name:DEAN, CARLTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3701
Mailing Address - Country:US
Mailing Address - Phone:217-429-1988
Mailing Address - Fax:217-429-9577
Practice Address - Street 1:1311 N STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3701
Practice Address - Country:US
Practice Address - Phone:217-429-1988
Practice Address - Fax:217-429-9577
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290218183500000X
TX42041183500000X
NY0521501183500000X
FLPS47399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist