Provider Demographics
NPI:1063830768
Name:MADDEN, CARRIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3245
Mailing Address - Country:US
Mailing Address - Phone:310-766-9581
Mailing Address - Fax:
Practice Address - Street 1:25821 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:424-251-7078
Practice Address - Fax:424-251-7160
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA717611835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program