Provider Demographics
NPI:1992306435
Name:DECKER, SEVANNE L (BSRPH)
Entity type:Individual
Prefix:
First Name:SEVANNE
Middle Name:L
Last Name:DECKER
Suffix:
Gender:F
Credentials:BSRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1851
Mailing Address - Country:US
Mailing Address - Phone:419-351-2959
Mailing Address - Fax:
Practice Address - Street 1:5500 MILAN RD STE 200
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7804
Practice Address - Country:US
Practice Address - Phone:419-627-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist