Provider Demographics
NPI:1427045103
Name:THAGARD, JOSEPH R (RPH, BCNSP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:THAGARD
Suffix:
Gender:M
Credentials:RPH, BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2301
Mailing Address - Country:US
Mailing Address - Phone:772-221-2015
Mailing Address - Fax:772-221-2013
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-221-2015
Practice Address - Fax:772-221-2013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 177371835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support