Provider Demographics
NPI:1518447580
Name:LOEHR, MADISON MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MICHELLE
Last Name:LOEHR
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 1:1350 S ELLSWORTH RD APT 2032
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2804
Mailing Address - Country:US
Mailing Address - Phone:712-346-8597
Mailing Address - Fax:
Practice Address - Street 1:255 NW VICTORIA DR STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4709
Practice Address - Country:US
Practice Address - Phone:855-937-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023416183500000X
MO2020004497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist