Provider Demographics
NPI:1467284786
Name:ESTES, MADISON GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:GRACE
Last Name:ESTES
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 1:2034 S HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9598
Mailing Address - Country:US
Mailing Address - Phone:502-222-2028
Mailing Address - Fax:
Practice Address - Street 1:2034 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9598
Practice Address - Country:US
Practice Address - Phone:502-222-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0245121835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist