Provider Demographics
NPI:1366729931
Name:MADIAR, KATHRYN N (PHARM D)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:N
Last Name:MADIAR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 BELLER RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4605
Mailing Address - Country:US
Mailing Address - Phone:630-985-6621
Mailing Address - Fax:
Practice Address - Street 1:501 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5341
Practice Address - Country:US
Practice Address - Phone:630-789-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist