Provider Demographics
NPI:1639897622
Name:WING, MADISON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:WING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40774 MT HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7745
Mailing Address - Country:US
Mailing Address - Phone:406-883-3674
Mailing Address - Fax:
Practice Address - Street 1:40774 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7745
Practice Address - Country:US
Practice Address - Phone:406-883-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-88655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist