Provider Demographics
NPI:1508885864
Name:MADSEN, JEFF (R PH)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:MADSEN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 N 5600 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-8725
Mailing Address - Country:US
Mailing Address - Phone:435-257-4725
Mailing Address - Fax:
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:SUITE JB
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-792-3407
Practice Address - Fax:435-792-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131393-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist