Provider Demographics
NPI:1326552571
Name:BEAN, MADELYNE C (PHA)
Entity Type:Individual
Prefix:
First Name:MADELYNE
Middle Name:C
Last Name:BEAN
Suffix:
Gender:F
Credentials:PHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 BIGHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3480
Mailing Address - Country:US
Mailing Address - Phone:970-229-9800
Mailing Address - Fax:970-229-1421
Practice Address - Street 1:2025 BIGHORN RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3480
Practice Address - Country:US
Practice Address - Phone:970-229-9800
Practice Address - Fax:970-229-1421
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0021980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist