Provider Demographics
NPI:1023530714
Name:DECKER, TRENT KJAR (RPH)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:KJAR
Last Name:DECKER
Suffix:
Gender:M
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:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-8058
Mailing Address - Fax:775-726-3666
Practice Address - Street 1:700 NO. SPRING ST.
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008
Practice Address - Country:US
Practice Address - Phone:775-726-3121
Practice Address - Fax:775-726-3666
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15165OtherSTATE PHARMACIST LICENSE