Provider Demographics
NPI:1619644184
Name:VANLOON, MADELINE LAUREL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:LAUREL
Last Name:VANLOON
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 1:2146 GREENVIEW CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4259
Mailing Address - Country:US
Mailing Address - Phone:616-878-8226
Mailing Address - Fax:
Practice Address - Street 1:2146 GREENVIEW CT SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4259
Practice Address - Country:US
Practice Address - Phone:248-881-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist