Healthcare Provider Details

I. General information

NPI: 1356669055
Provider Name (Legal Business Name): DEAN S MADAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W MAIN ST
WEST NEWTON PA
15089-1141
US

IV. Provider business mailing address

555 STATE ROUTE 981 PO BOX 678
SMITHTON PA
15479-0678
US

V. Phone/Fax

Practice location:
  • Phone: 724-872-6401
  • Fax: 724-872-9743
Mailing address:
  • Phone: 724-872-4522
  • Fax: 724-872-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035395L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: