Active NPI
Kathleen Marie Madden, RPH
- Pharmacist
- Moose Lake, MN
National Provider Identifier
1619316031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 114553
- Practice address
- 4570 County Hwy 61
Moose Lake, MN 55767 - Phone
- (218) 485-2111
- Fax
- (218) 485-8256
- NPI assigned
- Jun 19, 2013
- Last updated
- Jun 19, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 114553 | MN | Primary |
Addresses
Primary practice location
4570 County Hwy 61
Moose Lake, MN 55767
Mailing address
4240 County Road 11
Barnum, MN 55707-8731
Phone (218) 389-0094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114553 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371600000000",
"number": "1619316031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4240 COUNTY ROAD 11",
"city": "BARNUM",
"state": "MN",
"postal_code": "557078731",
"telephone_number": "218-389-0094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4570 COUNTY HWY 61",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "55767",
"telephone_number": "218-485-2111",
"fax_number": "218-485-8256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDEN",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-19",
"last_updated": "2013-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "114553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moose Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.