Healthcare Provider Details

I. General information

NPI: 1396452371
Provider Name (Legal Business Name): MADISON TREADWAY KENDRICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON TAYLOR TREADWAY PHARMD

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PROFESSIONAL PARK
ERWIN NC
28339-9106
US

IV. Provider business mailing address

164 HAZELWOOD RD
LILLINGTON NC
27546-4851
US

V. Phone/Fax

Practice location:
  • Phone: 910-230-7930
  • Fax: 910-230-7949
Mailing address:
  • Phone: 828-390-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29616
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700416
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: