MEDICARE: DECATUR WILL SAV INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	0000000320	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2088602	OTHER		PK

General Provider Information

NPI Number	:	1518012269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR WILL SAV INC

Provider Business Mailing Address
First Line	:	PO BOX 1316
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-1316
Country	:	US
Telephone Number	:	423-334-5223
Fax Number	:	423-334-9732

Provider Business Practice Location Address
First Line	:	17619 HWY 58 N
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322
Country	:	US
Telephone Number	:	423-334-5223
Fax Number	:	423-334-9732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER HARRSION
Credential	:
Telephone Number	:	423-334-5223

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/10/2016

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Directions to “DECATUR WILL SAV INC ” Practice Location

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