Provider Demographics
NPI:1982999744
Name:ARVIDSON THOLEN, DEBORAH LYNNE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNNE
Last Name:ARVIDSON THOLEN
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 1:6500 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3801
Mailing Address - Country:US
Mailing Address - Phone:520-290-1711
Mailing Address - Fax:
Practice Address - Street 1:6500 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3801
Practice Address - Country:US
Practice Address - Phone:520-290-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist