Provider Demographics
NPI:1558107680
Name:GOLDEN, MADDISON LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:LEE
Last Name:GOLDEN
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 1:25764 REDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9447
Mailing Address - Country:US
Mailing Address - Phone:574-904-7665
Mailing Address - Fax:
Practice Address - Street 1:32652 KNO
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9805
Practice Address - Country:US
Practice Address - Phone:269-782-4570
Practice Address - Fax:269-782-2996
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist