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NPI Code Detail

MEDICARE: MRS. DEBORAH ANN THIBODEAU RPH

MEDICARE: MRS. DEBORAH ANN THIBODEAU RPH
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
1183500000XPharmacist1124639MN

General Provider Information

NPI Number : 1467450932
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBORAH ANN THIBODEAU RPH
Provider Business Mailing Address
First Line : 13 GREENHAVEN BAY
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-9257
Country : US
Telephone Number : 507-334-2856
Fax Number :
Provider Business Practice Location Address
First Line : 1920 GRANT ST NW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-4831
Country : US
Telephone Number : 507-334-1555
Fax Number : 507-334-9030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 08/31/2011

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