Provider Demographics
NPI:1194849240
Name:THAGARD STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:THAGARD STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-644-8869
Mailing Address - Street 1:137 COLLEGIATE WAY FSU TSHC
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-2140
Mailing Address - Country:US
Mailing Address - Phone:850-644-8869
Mailing Address - Fax:850-644-1491
Practice Address - Street 1:137 COLLEGIATE WAY FSU TSHC
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-2140
Practice Address - Country:US
Practice Address - Phone:850-644-8869
Practice Address - Fax:850-644-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH82933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy