Provider Demographics
NPI:1578031209
Name:DECKERT, PATRICIA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:DECKERT
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 1:121 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1420
Mailing Address - Country:US
Mailing Address - Phone:973-383-4849
Mailing Address - Fax:973-383-2418
Practice Address - Street 1:121 WATER ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1420
Practice Address - Country:US
Practice Address - Phone:973-383-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02084400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist