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General NPI Number Information
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NPI Number | 1417432568
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Entity Type | Individual
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Provider Name | WILLIAM WYATT DECKER PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 14625 SW ALLEN BLVD
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City | BEAVERTON
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State | OR
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Zip | 97007-3697
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Country | US
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Telephone | 503-590-7346
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Fax | 503-590-2584
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Provider Business Mailing Address
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Address Line | 2725 NE JOHN OLSEN AVE APT C33
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City | HILLSBORO
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State | OR
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Zip | 97124-7174
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Country | US
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Telephone | 541-604-1681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0016875
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License Number State | OR
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