Provider Demographics
NPI:1114519543
Name:DECKARD, TYLER CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CHRISTIAN
Last Name:DECKARD
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 1:4400 GRANT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0038
Mailing Address - Country:US
Mailing Address - Phone:405-577-6775
Mailing Address - Fax:844-908-1423
Practice Address - Street 1:4400 GRANT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0038
Practice Address - Country:US
Practice Address - Phone:405-577-6775
Practice Address - Fax:844-908-1423
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200925650AMedicaid