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NPI Code Detail

MEDICARE: MR. HARRY A. THIBODEAU R.PH.

MEDICARE:  MR. HARRY A. THIBODEAU  R.PH.
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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist28RI01573300NJ

General Provider Information

NPI Number : 1437152071
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HARRY A. THIBODEAU R.PH.
Provider Business Mailing Address
First Line : 136 CENTRAL AVE
Second Line : PHARMA-CARE, INC.
City : CLARK
State : NJ
Zip : 07066-1142
Country : US
Telephone Number : 732-574-9015
Fax Number : 732-499-6778
Provider Business Practice Location Address
First Line : 136 CENTRAL AVE
Second Line :
City : CLARK
State : NJ
Zip : 07066-1142
Country : US
Telephone Number : 732-574-9015
Fax Number : 732-499-6778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 01/21/2010

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Directions to “ MR. HARRY A. THIBODEAU R.PH.” Practice Location

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