Healthcare Provider Details

I. General information

NPI: 1366915696
Provider Name (Legal Business Name): MADELYN SPEAKMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 E DUPONT RD
FORT WAYNE IN
46825-1759
US

IV. Provider business mailing address

4242 E DUPONT RD
FORT WAYNE IN
46825-1759
US

V. Phone/Fax

Practice location:
  • Phone: 260-279-2520
  • Fax: 260-279-2545
Mailing address:
  • Phone: 260-279-2520
  • Fax: 260-279-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26027963A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: