Healthcare Provider Details

I. General information

NPI: 1730878323
Provider Name (Legal Business Name): JOSHUA MADELUNG CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CALEF HWY
LEE NH
03861-6701
US

IV. Provider business mailing address

11 CEDAR LN
LEE NH
03861-4416
US

V. Phone/Fax

Practice location:
  • Phone: 603-868-6404
  • Fax:
Mailing address:
  • Phone: 603-583-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPHT-126963
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: