Provider Demographics
NPI:1326019696
Name:THIBODEAU, DONALD W (BS, RPH, PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:W
Last Name:THIBODEAU
Suffix:
Gender:M
Credentials:BS, RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8191 BRETON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4652
Mailing Address - Country:US
Mailing Address - Phone:239-768-0032
Mailing Address - Fax:239-768-2585
Practice Address - Street 1:8191 BRETON CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4652
Practice Address - Country:US
Practice Address - Phone:239-768-0032
Practice Address - Fax:239-768-2585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS356851835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy