Provider Demographics
NPI:1497030845
Name:DECKER, TERRY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:JEAN
Last Name:DECKER
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 1:7975 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7975
Mailing Address - Country:US
Mailing Address - Phone:317-272-5563
Mailing Address - Fax:317-272-7061
Practice Address - Street 1:7975 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7975
Practice Address - Country:US
Practice Address - Phone:317-272-5563
Practice Address - Fax:317-272-7061
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019329A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist