Provider Demographics
NPI:1801119557
Name:MADGY, AMANDA ROCHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROCHELLE
Last Name:MADGY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROCHELLE
Other - Last Name:TEVLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 725204
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-9998
Mailing Address - Country:US
Mailing Address - Phone:248-421-1861
Mailing Address - Fax:
Practice Address - Street 1:121 ALGONQUIN PKWY
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1601
Practice Address - Country:US
Practice Address - Phone:973-503-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033724183500000X
NJ28RI03139500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist