Provider Demographics
NPI:1437152071
Name:THIBODEAU, HARRY A (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:A
Last Name:THIBODEAU
Suffix:
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 1:136 CENTRAL AVE
Mailing Address - Street 2:PHARMA-CARE, INC.
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1142
Mailing Address - Country:US
Mailing Address - Phone:732-574-9015
Mailing Address - Fax:732-499-6778
Practice Address - Street 1:136 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1142
Practice Address - Country:US
Practice Address - Phone:732-574-9015
Practice Address - Fax:732-499-6778
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI015733001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist