Provider Demographics
NPI:1902588742
Name:ROME, MADELAINE CAROL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:CAROL
Last Name:ROME
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 1:1042 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-2842
Mailing Address - Country:US
Mailing Address - Phone:620-544-8512
Mailing Address - Fax:
Practice Address - Street 1:1042 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2842
Practice Address - Country:US
Practice Address - Phone:620-544-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist