MEDICARE: REGINA TRENTADUE DECKER

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	8287	NC

General Provider Information

NPI Number	:	1508165622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA TRENTADUE DECKER

Provider Business Mailing Address
First Line	:	3603 TIMBEROAK DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2142
Country	:	US
Telephone Number	:	336-545-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3391 BATTLEGROUND AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2401
Country	:	US
Telephone Number	:	336-282-0556
Fax Number	:

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

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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