Provider Demographics
NPI:1497517478
Name:LESTER, MADISON RENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:RENE
Last Name:LESTER
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 1:12997 E 120TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-1115
Mailing Address - Country:US
Mailing Address - Phone:318-834-5598
Mailing Address - Fax:
Practice Address - Street 1:19801 ROBSON RD
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-1510
Practice Address - Country:US
Practice Address - Phone:918-739-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist