Provider Demographics
NPI:1427768704
Name:AHLSTROM, MADISON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61-1011 TUTU PL
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1356
Mailing Address - Country:US
Mailing Address - Phone:209-275-8198
Mailing Address - Fax:
Practice Address - Street 1:56-119 PUALALEA ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2052
Practice Address - Country:US
Practice Address - Phone:808-293-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4515183500000X
TN43570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist