MEDICARE: DR. MADELINE M BANDOMER PHARMD, RPH

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	28RI04197200	NJ

General Provider Information

NPI Number	:	1679243166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELINE M BANDOMER PHARMD, RPH

Provider Business Mailing Address
First Line	:	183 PESHEKEE TRL
Second Line	:
City	:	MEDFORD LAKES
State	:	NJ
Zip	:	08055-1719
Country	:	US
Telephone Number	:	609-760-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2093 ROUTE 130 N
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-9748
Country	:	US
Telephone Number	:	609-499-5781
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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