Provider Demographics
NPI:1306121751
Name:DECKER, JOHN ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
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 1:3545 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1930
Mailing Address - Country:US
Mailing Address - Phone:317-228-0419
Mailing Address - Fax:317-228-0497
Practice Address - Street 1:3545 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1930
Practice Address - Country:US
Practice Address - Phone:317-228-0419
Practice Address - Fax:317-228-0497
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist