Healthcare Provider Details

I. General information

NPI: 1386427441
Provider Name (Legal Business Name): MADELYNN AEILTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E 28TH ST
MINNEAPOLIS MN
55407-1394
US

IV. Provider business mailing address

500 E GRANT ST APT 1905
MINNEAPOLIS MN
55404-1478
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-0770
  • Fax:
Mailing address:
  • Phone: 605-413-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127464
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: