Healthcare Provider Details

I. General information

NPI: 1619374782
Provider Name (Legal Business Name): SHAWN DECK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 MAIN ST
PLACERVILLE CA
95667-5689
US

IV. Provider business mailing address

359 MAIN ST
PLACERVILLE CA
95667-5689
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-3186
  • Fax:
Mailing address:
  • Phone: 530-622-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH71858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: