Healthcare Provider Details

I. General information

NPI: 1750226320
Provider Name (Legal Business Name): MADISON ROSE TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SHERIDAN BLVD
EDGEWATER CO
80214-1303
US

IV. Provider business mailing address

8355 E 32ND AVE APT 333
DENVER CO
80238-4434
US

V. Phone/Fax

Practice location:
  • Phone: 303-237-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025536
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: