Logan Thibodeaux, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

46240 Issued in LA

Practice address

655 W 8TH St
Jacksonville, FL 32209-6511

Phone

(904) 244-4157

NPI assigned

Mar 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374883200000",
    "number": "1861735953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 FONTENOT RD",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705701845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-4157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAUX",
        "first_name": "LOGAN",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2013-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "46240",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "LA",
            "license": "46240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Theriault, DO
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• Thewrightonehomeandfamilycare
• Ryan Thibeault, AS
• David Thiel, MD
• Scott Lindstrom Thiele, OD
• Daniel George Thielemann, MD
• Jacqueline M Thielen, M.D.
• Kaitlyn Thiessen

• Pharmacist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.