Provider Demographics
NPI:1780200741
Name:MADEWELL, ANNA LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEIGH
Last Name:MADEWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LEIGH
Other - Last Name:TAUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13801 W 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-3115
Mailing Address - Country:US
Mailing Address - Phone:219-616-4858
Mailing Address - Fax:
Practice Address - Street 1:6001 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3506
Practice Address - Country:US
Practice Address - Phone:219-762-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028295A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist