Provider Demographics
NPI:1366829947
Name:JANAS-FOREMAN, MADONNA EILEEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MADONNA
Middle Name:EILEEN
Last Name:JANAS-FOREMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 80TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4908
Mailing Address - Country:US
Mailing Address - Phone:262-697-5744
Mailing Address - Fax:262-697-5749
Practice Address - Street 1:3207 80TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4908
Practice Address - Country:US
Practice Address - Phone:262-697-5744
Practice Address - Fax:262-697-5749
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12746-40183500000X
SC9156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist