Provider Demographics
NPI:1396489381
Name:GARRETT, MADISON CHAISE (PHARMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:CHAISE
Last Name:GARRETT
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 1:36320 E 221ST ST S
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:OK
Mailing Address - Zip Code:74454-5418
Mailing Address - Country:US
Mailing Address - Phone:918-521-7351
Mailing Address - Fax:
Practice Address - Street 1:1300 E ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8951
Practice Address - Country:US
Practice Address - Phone:918-505-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist