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NPI Code Detail

MEDICARE: DR. VERNE ANTHONY THIBODEAUX JR. PHARM.D

MEDICARE: DR. VERNE ANTHONY THIBODEAUX JR. PHARM.D
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
1183500000XPharmacist43659TX

General Provider Information

NPI Number : 1518253772
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VERNE ANTHONY THIBODEAUX JR. PHARM.D
Provider Business Mailing Address
First Line : 301 CARROLL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1956
Country : US
Telephone Number : 817-302-0291
Fax Number : 817-302-0291
Provider Business Practice Location Address
First Line : 301 CARROLL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1956
Country : US
Telephone Number : 817-302-0291
Fax Number : 817-302-0291
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 06/24/2011

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