Provider Demographics
NPI:1902129992
Name:DUEZ, AUGUST WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:WALTER
Last Name:DUEZ
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 1:2909 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6203
Mailing Address - Country:US
Mailing Address - Phone:309-347-5936
Mailing Address - Fax:
Practice Address - Street 1:2909 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6203
Practice Address - Country:US
Practice Address - Phone:309-347-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist