Provider Demographics
NPI:1750446175
Name:MADISON PHARMACY AND HOMECARE
Entity Type:Organization
Organization Name:MADISON PHARMACY AND HOMECARE
Other - Org Name:MADISON PHARMACY AND HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-548-0049
Mailing Address - Street 1:125 W MURPHY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1923
Mailing Address - Country:US
Mailing Address - Phone:336-548-0049
Mailing Address - Fax:336-548-0059
Practice Address - Street 1:125 W MURPHY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1923
Practice Address - Country:US
Practice Address - Phone:336-548-0049
Practice Address - Fax:336-548-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC083803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0795808Medicaid
2069951OtherPK
4984680001Medicare NSC