Provider Demographics
NPI:1588335657
Name:SMITH, MADISON ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12061 SW LAUSANNE ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7381
Mailing Address - Country:US
Mailing Address - Phone:503-360-2608
Mailing Address - Fax:
Practice Address - Street 1:1839 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4071
Practice Address - Country:US
Practice Address - Phone:503-657-1483
Practice Address - Fax:503-657-1480
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist