Provider Demographics
NPI:1841952793
Name:DECKER, CHRISTOPHER NICHOLAS
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NICHOLAS
Last Name:DECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4203
Mailing Address - Country:US
Mailing Address - Phone:330-861-0849
Mailing Address - Fax:
Practice Address - Street 1:41 5TH ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4203
Practice Address - Country:US
Practice Address - Phone:330-861-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist