Provider Demographics
NPI:1518012269
Name:DECATUR WILL SAV INC
Entity Type:Organization
Organization Name:DECATUR WILL SAV INC
Other - Org Name:WIL SAV DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRSION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-334-5223
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-1316
Mailing Address - Country:US
Mailing Address - Phone:423-334-5223
Mailing Address - Fax:423-334-9732
Practice Address - Street 1:17619 HWY 58 N
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322
Practice Address - Country:US
Practice Address - Phone:423-334-5223
Practice Address - Fax:423-334-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000003203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452294Medicaid
2088602OtherPK
1184320001Medicare NSC
TN1452294Medicaid