Provider Demographics
NPI:1588077325
Name:MADISON PHARMACY INC.
Entity type:Organization
Organization Name:MADISON PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED AMINODDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRRAMEZANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-466-0484
Mailing Address - Street 1:8498 MADISON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2049
Mailing Address - Country:US
Mailing Address - Phone:256-325-1139
Mailing Address - Fax:256-325-1159
Practice Address - Street 1:8498 MADISON BLVD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2049
Practice Address - Country:US
Practice Address - Phone:256-325-1139
Practice Address - Fax:256-325-1159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
AL1143703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146244OtherPK