Provider Demographics
NPI:1124158308
Name:THIBODEAUX, PAUL E (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:THIBODEAUX
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 1:1304 ROSEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1436
Mailing Address - Country:US
Mailing Address - Phone:214-402-8580
Mailing Address - Fax:
Practice Address - Street 1:4835 N O CONNOR RD
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2720
Practice Address - Country:US
Practice Address - Phone:972-580-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33151183500000X
LA13132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist