Provider Demographics
NPI:1518012053
Name:DOBEK, THADDEUS P (RPH)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:P
Last Name:DOBEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13716 IOWA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-5841
Mailing Address - Country:US
Mailing Address - Phone:586-774-9348
Mailing Address - Fax:586-228-4595
Practice Address - Street 1:43750 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1135
Practice Address - Country:US
Practice Address - Phone:586-228-4589
Practice Address - Fax:586-228-4595
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302021501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist