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NPI Code Detail

MEDICARE: AMANDA DECOTES

MEDICARE: AMANDA DECOTES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist71905CA

General Provider Information

NPI Number : 1366849143
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DECOTES
Provider Business Mailing Address
First Line : 1158 W MAIN ST
Second Line :
City : MERCED
State : CA
Zip : 95340-4523
Country : US
Telephone Number : 209-383-2404
Fax Number : 209-383-1141
Provider Business Practice Location Address
First Line : 1158 W MAIN ST
Second Line :
City : MERCED
State : CA
Zip : 95340-4523
Country : US
Telephone Number : 209-383-2404
Fax Number : 209-383-1141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2014
Last Update Date : 11/22/2014

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Directions to “ AMANDA DECOTES ” Practice Location

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