Healthcare Provider Details

I. General information

NPI: 1033685383
Provider Name (Legal Business Name): MADISON CAUDLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 JOHNNIE DODDS BLVD
MT PLEASANT SC
29464-2932
US

IV. Provider business mailing address

212 EVESHAM DR
SUMMERVILLE SC
29485-5847
US

V. Phone/Fax

Practice location:
  • Phone: 843-972-4068
  • Fax: 843-972-4069
Mailing address:
  • Phone: 843-906-3973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37415
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: