Healthcare Provider Details

I. General information

NPI: 1447165071
Provider Name (Legal Business Name): MADISON KATHLEEN PHILLIPS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

10 BRIELLE DR
TROY NY
12182-1059
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: