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General NPI Number Information
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NPI Number | 1841800992
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Entity Type | Individual
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Provider Name | CRAIG THIBEAULT RPH
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Gender | Male
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 12810 S TRYON ST
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City | CHARLOTTE
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State | NC
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Zip | 28273-6949
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Country | US
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Telephone | 704-587-0513
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Fax |
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Provider Business Mailing Address
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Address Line | 60 TAGGART CT
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1085
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Country | US
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Telephone | 704-299-1637
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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 | 16984
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License Number State | NC
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