Provider Demographics
NPI:1386616274
Name:DECKER, KRISTA G (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:G
Last Name:DECKER
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 1:18 SPARROW HILL CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2544
Mailing Address - Country:US
Mailing Address - Phone:410-869-0058
Mailing Address - Fax:
Practice Address - Street 1:18 SPARROW HILL CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2544
Practice Address - Country:US
Practice Address - Phone:410-869-0058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist