Provider Demographics
NPI:1851878706
Name:MADEJ, ANDY
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:
Last Name:MADEJ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MADEJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:4333 BUTLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3717
Mailing Address - Country:US
Mailing Address - Phone:314-894-2484
Mailing Address - Fax:
Practice Address - Street 1:4333 BUTLER HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3717
Practice Address - Country:US
Practice Address - Phone:314-894-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist