Provider Demographics
NPI:1053920272
Name:MADSEN, EMILY MARIN (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIN
Last Name:MADSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 14TH ST W STE 150
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4080
Mailing Address - Country:US
Mailing Address - Phone:701-572-7979
Mailing Address - Fax:
Practice Address - Street 1:1500 14TH ST W STE 150
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4080
Practice Address - Country:US
Practice Address - Phone:701-572-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-71031183500000X
NDRPH6278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist