Provider Demographics
NPI:1669334611
Name:ZURITA, MADISON MARIE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:ZURITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2523
Mailing Address - Country:US
Mailing Address - Phone:830-816-2093
Mailing Address - Fax:866-570-0960
Practice Address - Street 1:420 W BANDERA RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2523
Practice Address - Country:US
Practice Address - Phone:830-816-2093
Practice Address - Fax:866-570-0960
Is Sole Proprietor?:No
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336007183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician