MEDICARE: SEVANNE L DECKER BSRPH

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	03224808	OH

General Provider Information

NPI Number	:	1992306435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEVANNE L DECKER BSRPH

Provider Business Mailing Address
First Line	:	314 BELLE AVE
Second Line	:
City	:	BELLEVUE
State	:	OH
Zip	:	44811-1851
Country	:	US
Telephone Number	:	419-351-2959
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 MILAN RD STE 200
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-7804
Country	:	US
Telephone Number	:	419-627-8283
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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