Provider Demographics
NPI:1942802186
Name:DUTEAU, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DUTEAU
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 1:40 INTERNATIONAL DR S
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-4199
Mailing Address - Country:US
Mailing Address - Phone:973-347-8060
Mailing Address - Fax:973-347-8695
Practice Address - Street 1:40 INTERNATIONAL DR S
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-4106
Practice Address - Country:US
Practice Address - Phone:973-347-8060
Practice Address - Fax:973-347-8695
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02476500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist