Healthcare Provider Details

I. General information

NPI: 1871413849
Provider Name (Legal Business Name): MADISON MAY MORTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BLUE LAKES BLVD N
TWIN FALLS ID
83301-4007
US

IV. Provider business mailing address

705 BLUE LAKES BLVD N
TWIN FALLS ID
83301-4007
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-5373
  • Fax:
Mailing address:
  • Phone: 208-736-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9781013
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: