Provider Demographics
NPI:1134635055
Name:GOLEBIEWSKI, THADDEUS JOHN III (RPH)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:JOHN
Last Name:GOLEBIEWSKI
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 OLD MUSKET DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3430
Mailing Address - Country:US
Mailing Address - Phone:860-666-8538
Mailing Address - Fax:
Practice Address - Street 1:1181 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3033
Practice Address - Country:US
Practice Address - Phone:860-667-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist