Healthcare Provider Details

I. General information

NPI: 1205183167
Provider Name (Legal Business Name): EMILY KATE MADOLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 E SUPERIOR ST
DULUTH MN
55802-2221
US

IV. Provider business mailing address

1131 E SUPERIOR ST
DULUTH MN
55802-2221
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-3060
  • Fax: 218-724-1853
Mailing address:
  • Phone: 218-724-3060
  • Fax: 218-724-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120991
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: