Healthcare Provider Details

I. General information

NPI: 1518012269
Provider Name (Legal Business Name): DECATUR WILL SAV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17619 HWY 58 N
DECATUR TN
37322
US

IV. Provider business mailing address

PO BOX 1316
DECATUR TN
37322-1316
US

V. Phone/Fax

Practice location:
  • Phone: 423-334-5223
  • Fax: 423-334-9732
Mailing address:
  • Phone: 423-334-5223
  • Fax: 423-334-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000000320
License Number StateTN

VIII. Authorized Official

Name: ROGER HARRSION
Title or Position: PRESIDENT
Credential:
Phone: 423-334-5223