Provider Demographics
NPI:1669066023
Name:MEISTER, MADELINE M
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:MEISTER
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 1:1132 WESTGATE ST APT 214
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1380
Mailing Address - Country:US
Mailing Address - Phone:651-500-7474
Mailing Address - Fax:
Practice Address - Street 1:3910 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2470
Practice Address - Country:US
Practice Address - Phone:872-588-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist