Provider Demographics
NPI:1467774976
Name:MADEJSKI, ROSE MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROSE MARY
Middle Name:
Last Name:MADEJSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ROSE MARY
Other - Middle Name:
Other - Last Name:MADEJSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1285 WEST RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072
Mailing Address - Country:US
Mailing Address - Phone:716-773-9518
Mailing Address - Fax:
Practice Address - Street 1:1285 W RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2421
Practice Address - Country:US
Practice Address - Phone:716-773-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist