Provider Demographics
NPI:1164704987
Name:DECUIR, DAVID MORRIS (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MORRIS
Last Name:DECUIR
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 1:807 S HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9531
Mailing Address - Country:US
Mailing Address - Phone:502-222-6550
Mailing Address - Fax:502-222-6650
Practice Address - Street 1:807 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9531
Practice Address - Country:US
Practice Address - Phone:502-222-6550
Practice Address - Fax:502-222-6650
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011639OtherPHARMACY LICENSE NUMBER