Provider Demographics
NPI:1972632230
Name:MADSEN, TIMOTHY T (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:T
Last Name:MADSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 RICHARD LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4412
Mailing Address - Country:US
Mailing Address - Phone:641-752-1431
Mailing Address - Fax:641-484-4642
Practice Address - Street 1:108 2ND AVE W
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2140
Practice Address - Country:US
Practice Address - Phone:641-484-6198
Practice Address - Fax:641-484-4642
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0225649Medicaid
IA4015110001Medicare NSC