Madelaine Rae Tech
Individual provider Active NPI Pharmacist · Winterhaven, CA
NPI 1104437706 · NPPES record last updated Mar 18, 2021
Key facts
- NPI
- 1104437706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S024291 (AZ)
- Practice address
- 401 Picacho Rd
Winterhaven, CA 92283-9605 - Phone
- (760) 572-4742
- NPI assigned
- Aug 17, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S024291 | AZ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S024291 | AZ | Yes |
Addresses
Primary practice location
401 Picacho Rd
Winterhaven, CA 92283-9605
Mailing address
401 Picacho Rd
Winterhaven, CA 92283-9605
Phone (760) 572-4120
Other providers in Winterhaven, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.