=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750226320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON ROSE TAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 SHERIDAN BLVD
-----------------------------------------------------
City | EDGEWATER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80214-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-237-6140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8355 E 32ND AVE APT 333
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80238-4434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHA.0025536
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------