Basic Information
| Provider Information | |||||||||
| NPI: | 1437152071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THIBODEAU | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | PHARMA-CARE, INC. | ||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325749015 | ||||||||
| FaxNumber: | 7324996778 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325749015 | ||||||||
| FaxNumber: | 7324996778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 28RI01573300 | NJ | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.