Provider Demographics
NPI:1184013617
Name:KANE, MADOUSSOU
Entity Type:Individual
Prefix:
First Name:MADOUSSOU
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 SHADOWBRIAR DR
Mailing Address - Street 2:# 835
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-8318
Mailing Address - Country:US
Mailing Address - Phone:561-312-3864
Mailing Address - Fax:
Practice Address - Street 1:2920 SHADOWBRIAR DR
Practice Address - Street 2:# 835
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-8318
Practice Address - Country:US
Practice Address - Phone:561-312-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist