Provider Demographics
NPI:1235563479
Name:OLEA, MADELLE AUDREY A
Entity Type:Individual
Prefix:
First Name:MADELLE AUDREY
Middle Name:A
Last Name:OLEA
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 1:912 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7679
Mailing Address - Country:US
Mailing Address - Phone:773-665-8990
Mailing Address - Fax:773-665-9766
Practice Address - Street 1:912 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7679
Practice Address - Country:US
Practice Address - Phone:773-665-8990
Practice Address - Fax:773-665-9766
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist