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General NPI Number Information
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NPI Number | 1356015663
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Entity Type | Individual
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Provider Name | KEVIN MADDEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 1929 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9202
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Country | US
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Telephone | 813-991-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 18129 PHEASANT WALK DR
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City | TAMPA
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State | FL
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Zip | 33647-3141
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Country | US
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Telephone | 561-301-7517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS62794
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License Number State | FL
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