Provider Demographics
NPI:1912287475
Name:VOLLAND-GOLDEN, MADONA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:MADONA
Middle Name:M
Last Name:VOLLAND-GOLDEN
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 1:5874 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1645
Mailing Address - Country:US
Mailing Address - Phone:773-284-7419
Mailing Address - Fax:773-284-7595
Practice Address - Street 1:5874 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1645
Practice Address - Country:US
Practice Address - Phone:773-284-7419
Practice Address - Fax:773-284-7595
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361924025013Medicaid