Provider Demographics
NPI:1447760343
Name:DECKLING, TRACI LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:DECKLING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 COUNTY ROAD 135
Mailing Address - Street 2:
Mailing Address - City:DOLA
Mailing Address - State:OH
Mailing Address - Zip Code:45835-9733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1503
Practice Address - Country:US
Practice Address - Phone:419-634-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03319901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist