Healthcare Provider Details

I. General information

NPI: 1750446175
Provider Name (Legal Business Name): MADISON PHARMACY AND HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MURPHY ST
MADISON NC
27025-1923
US

IV. Provider business mailing address

125 W MURPHY ST
MADISON NC
27025-1923
US

V. Phone/Fax

Practice location:
  • Phone: 336-548-0049
  • Fax: 336-548-0059
Mailing address:
  • Phone: 336-548-0049
  • Fax: 336-548-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08380
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0795808
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier2069951
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: RHONDA CALDWELL
Title or Position: OWNER/PRESIDENT
Credential: PHARMD
Phone: 336-548-0049