Provider Demographics
NPI:1780307801
Name:DECKARD, JAROD MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAROD
Middle Name:MATTHEW
Last Name:DECKARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5269 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47462-5432
Mailing Address - Country:US
Mailing Address - Phone:812-797-1155
Mailing Address - Fax:
Practice Address - Street 1:930 N GOSPEL ST
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9218
Practice Address - Country:US
Practice Address - Phone:812-723-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029929A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist