Provider Demographics
NPI:1326459165
Name:DEJAGER, DEBORAH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:DEJAGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PLACERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3919
Mailing Address - Country:US
Mailing Address - Phone:530-622-6630
Mailing Address - Fax:530-622-3071
Practice Address - Street 1:166 PLACERVILLE DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3919
Practice Address - Country:US
Practice Address - Phone:530-622-6630
Practice Address - Fax:530-622-3071
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist