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General NPI Number Information
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NPI Number | 1619719085
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Entity Type | Individual
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Provider Name | MADISON ELIZABETH PEACH-KEEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 3715 E OVERLAND RD STE 115
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 803-727-8659
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 E OVERLAND RD STE 115
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 803-727-8659
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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 | P9223
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License Number State | ID
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