Provider Demographics
NPI:1295753846
Name:THIES, GEORGE FREDRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FREDRICK
Last Name:THIES
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 1:1413 GROTON LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-7747
Mailing Address - Country:US
Mailing Address - Phone:630-510-9023
Mailing Address - Fax:630-980-0908
Practice Address - Street 1:156 S BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1472
Practice Address - Country:US
Practice Address - Phone:630-980-9198
Practice Address - Fax:630-980-0908
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist