Provider Demographics
NPI:1164195376
Name:REED, MADISON NICOLE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:REED
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100A E WASHINGTON JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9729
Mailing Address - Country:US
Mailing Address - Phone:740-222-9023
Mailing Address - Fax:
Practice Address - Street 1:100A E WASHINGTON JACKSON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9729
Practice Address - Country:US
Practice Address - Phone:937-456-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist