Provider Demographics
NPI:1467450932
Name:THIBODEAU, DEBORAH ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GREENHAVEN BAY
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-9257
Mailing Address - Country:US
Mailing Address - Phone:507-334-2856
Mailing Address - Fax:
Practice Address - Street 1:1920 GRANT ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4831
Practice Address - Country:US
Practice Address - Phone:507-334-1555
Practice Address - Fax:507-334-9030
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1124639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist