Provider Demographics
NPI:1265842066
Name:MADSEN, JOSEPH WAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:MADSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 S SNOWBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1824
Mailing Address - Country:US
Mailing Address - Phone:334-559-4572
Mailing Address - Fax:
Practice Address - Street 1:8607 S SNOWBIRD DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1824
Practice Address - Country:US
Practice Address - Phone:334-559-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318327-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist