Healthcare Provider Details

I. General information

NPI: 1346177219
Provider Name (Legal Business Name): DR. THEA ABOU JAOUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S WALNUT ST
BLOOMINGTON IN
47401-7302
US

IV. Provider business mailing address

650 S PEYTON CIR APT 205
BLOOMINGTON IN
47404-8043
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-6223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: