Provider Demographics
NPI:1376090324
Name:SHIBILSKI, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:SHIBILSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41650 W MARICOPA CASA GRANDE HWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3206
Mailing Address - Country:US
Mailing Address - Phone:520-568-3302
Mailing Address - Fax:
Practice Address - Street 1:41650 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3206
Practice Address - Country:US
Practice Address - Phone:520-568-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist