Provider Demographics
NPI:1518689363
Name:ALEVA, MADISON KAY
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAY
Last Name:ALEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 BEECH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-6311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:674 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4216
Practice Address - Country:US
Practice Address - Phone:603-431-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist