Provider Demographics
NPI:1265574792
Name:THELEN, BARBARA JEAN (PHARMD04)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:THELEN
Suffix:
Gender:F
Credentials:PHARMD04
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SE DOCK ST
Mailing Address - Street 2:#101
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4045
Mailing Address - Country:US
Mailing Address - Phone:360-679-8499
Mailing Address - Fax:360-679-8498
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3413
Practice Address - Country:US
Practice Address - Phone:360-678-7656
Practice Address - Fax:360-678-7630
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist