MEDICARE: MR. JAMES WINFIELD DECKER PHARMACIST

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
1	183500000X	Pharmacist	0006575	OR
2	183500000X	Pharmacist	12165	WA

General Provider Information

NPI Number	:	1427319177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES WINFIELD DECKER PHARMACIST

Provider Business Mailing Address
First Line	:	5639 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	503-656-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	5639 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	503-656-0306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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