Provider Demographics
NPI:1265168454
Name:ONSTOTT, MADISON BAILEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:BAILEY
Last Name:ONSTOTT
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 1:1210 ESTATES AVE APT 2129
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-0233
Mailing Address - Country:US
Mailing Address - Phone:618-364-7517
Mailing Address - Fax:
Practice Address - Street 1:1300B EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5802
Practice Address - Country:US
Practice Address - Phone:704-910-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist