Healthcare Provider Details

I. General information

NPI: 1639064298
Provider Name (Legal Business Name): THOMAS THIELBAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

100 BOUCLE JEANNE CIR APT 248
MAITLAND FL
32751-6620
US

V. Phone/Fax

Practice location:
  • Phone: 317-941-9029
  • Fax:
Mailing address:
  • Phone: 317-941-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS67178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS67178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: