Provider Demographics
NPI:1669525549
Name:MADDEN MENTAL HEALTH PHARMACY
Entity type:Organization
Organization Name:MADDEN MENTAL HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-338-7319
Mailing Address - Street 1:1200 S. 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-7000
Mailing Address - Country:US
Mailing Address - Phone:708-338-7319
Mailing Address - Fax:708-338-7088
Practice Address - Street 1:1200 S. 1ST AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-7000
Practice Address - Country:US
Practice Address - Phone:708-338-7319
Practice Address - Fax:708-338-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL058.0134873336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy