Provider Demographics
NPI:1457427718
Name:THIBEAULT, JOSEPH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:THIBEAULT
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 1:467 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-443-0421
Mailing Address - Fax:860-443-0426
Practice Address - Street 1:467 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-228-3888
Practice Address - Fax:860-228-3391
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist