Provider Demographics
NPI:1326494428
Name:DECKER, JAN CAROL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:CAROL
Last Name:DECKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:JAN
Other - Middle Name:CAROL
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:16975 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1809
Mailing Address - Country:US
Mailing Address - Phone:760-947-7043
Mailing Address - Fax:760-947-7853
Practice Address - Street 1:16975 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1809
Practice Address - Country:US
Practice Address - Phone:760-947-7043
Practice Address - Fax:760-947-7853
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist