Provider Demographics
NPI:1790338820
Name:HUNTER, MADISON (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HUNTER
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 1:3383 PRIMROSE CT APT C2
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5816
Mailing Address - Country:US
Mailing Address - Phone:701-741-5171
Mailing Address - Fax:
Practice Address - Street 1:2475 32ND AVE S STE 1
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3606
Practice Address - Country:US
Practice Address - Phone:701-775-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist