MEDICARE: MR. DEAN J ABBOTT RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	039852	NY
2	183500000X	Pharmacist	28R102328500	NJ

General Provider Information

NPI Number	:	1629052048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEAN J ABBOTT RPH

Provider Business Mailing Address
First Line	:	21 VICTORY RD
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-3717
Country	:	US
Telephone Number	:	845-357-8646
Fax Number	:	845-357-8646

Provider Business Practice Location Address
First Line	:	21 VICTORY RD
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-3717
Country	:	US
Telephone Number	:	845-357-8646
Fax Number	:	845-357-8646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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