Provider Demographics
NPI:1871264333
Name:SWEENEY, MADISON BLAIR
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BLAIR
Last Name:SWEENEY
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 1:10241 SADDLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-5337
Mailing Address - Country:US
Mailing Address - Phone:502-974-8740
Mailing Address - Fax:
Practice Address - Street 1:10241 SADDLE POINTE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-5337
Practice Address - Country:US
Practice Address - Phone:502-974-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYI14416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist