Provider Demographics
NPI:1487021044
Name:HOOVER, MADISON (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 OLDE REGENT WAY
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4192
Mailing Address - Country:US
Mailing Address - Phone:910-371-0440
Mailing Address - Fax:910-371-0442
Practice Address - Street 1:2021 OLDE REGENT WAY
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4192
Practice Address - Country:US
Practice Address - Phone:910-371-0440
Practice Address - Fax:910-371-0442
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist