MADISON MEDICAL COMPOUNDING PHARMACY (NPI# 1912488198) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912488198 |
| Entity Type | Organization |
| Organization Name | MADISON MEDICAL COMPOUNDING PHARMACY |
| Practice Address |
111 Fountains Blvd. Building B Ste. A Madison MS 39110 |
| Practice Telephone | 6017077545 |
| Mailing Telephone | 6017077545 |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-24 |
| Authorized Official Name | KRISTEN LEANN CHAMBERS (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 6628204305 |
| Authorized Official Credential | PHARM.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
17118 | MS | Suppliers |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
17118 | MS | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | FM7614642 | 01 |
| Street Address |
111 FOUNTAINS BLVD. BUILDING B STE. A |
| City | MADISON |
| State | MS |
| Zip Code | 39110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| 1932651429 | Laura Leone | Nurse Practitioner | 117 Fountains Blvd, Madison, MS 39110 | 2016-10-31 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508311028 | Koshy Mathew | Pharmacist | 122 Mcdill Cv, Madison, MS 39110-6562 | 2016-08-25 |
| 1245629716 | Donald Lee Michalski | Pharmacist | 1 Classic Cir, Madison, WI 53719-4437 | 2015-01-21 |
| 1467840801 | Pooja Arora | Pharmacist | 7545 Tree Ln Apt 102g, Madison, WI 53717-2185 | 2015-01-08 |
| 1962702399 | Connie Kroll Kraus | Pharmacist | 701 Dane St. Access Community Health Center, Wingra Family Medical Center, Madison, WI 53713-1900 | 2010-11-02 |
| 1861015174 | Donald Marlowe | Pharmacist | 4579 Wall Triana Hwy, Madison, AL 35758-9305 | 2020-05-20 |
| 1144850140 | Carol P Wisdom | Pharmacist | 4579 Wall Triana Hwy, Madison, AL 35758-9305 | 2020-01-19 |
| 1083253272 | Susan Carol Storm | Pharmacist | 525 E Clifty Dr, Madison, IN 47250-1672 | 2020-01-06 |
| 1669011185 | Vanessa Wrightsman | Pharmacist | 525 E Clifty Dr, Madison, IN 47250-1672 | 2020-01-01 |
| 1982243622 | Mandy Jo Collins | Pharmacist | 525 E Clifty Dr, Madison, IN 47250-1672 | 2019-12-28 |
| 1467090258 | Chad Franklin Stewart | Pharmacist | 115 Colony Crossing Way, Madison, MS 39110 | 2019-12-12 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.