MEDICARE: MR. JEFF MADSEN R. PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	131393-1701	UT

General Provider Information

NPI Number	:	1508885864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF MADSEN R. PH.

Provider Business Mailing Address
First Line	:	11080 N 5600 W
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-8725
Country	:	US
Telephone Number	:	435-257-4725
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 E 1400 N
Second Line	:	SUITE JB
City	:	LOGAN
State	:	UT
Zip	:	84341-2406
Country	:	US
Telephone Number	:	435-792-3407
Fax Number	:	435-792-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JEFF MADSEN R. PH.” Practice Location

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