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General NPI Number Information
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NPI Number | 1194150912
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Entity Type | Individual
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Provider Name | MARIBEL THIEBAUD PHARM D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 1601 N WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60614-6001
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Country | US
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Telephone | 312-642-4008
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 N LAKEVIEW AVE APT 810
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City | CHICAGO
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State | IL
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Zip | 60614-2734
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Country | US
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Telephone | 989-980-0083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.296911
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License Number State | IL
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