Provider Demographics
NPI:1750680237
Name:MADL, COURTNEY LYN
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYN
Last Name:MADL
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 1:918 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3410
Mailing Address - Country:US
Mailing Address - Phone:570-417-8579
Mailing Address - Fax:
Practice Address - Street 1:400 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4635
Practice Address - Country:US
Practice Address - Phone:570-752-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439735183500000X
MAPH25821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist