Provider Demographics
NPI:1174707681
Name:DECKER, WILLIAM GLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLEN
Last Name:DECKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3674 E COUNTRY FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5101
Mailing Address - Country:US
Mailing Address - Phone:907-376-8200
Mailing Address - Fax:907-376-8195
Practice Address - Street 1:3674 E COUNTRY FIELD CIR
Practice Address - Street 2:MEDSET
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5101
Practice Address - Country:US
Practice Address - Phone:907-376-8200
Practice Address - Fax:907-376-8195
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4740953-1701183500000X
AK2007183500000X
IDP6491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist