Provider Demographics
NPI:1356232276
Name:WELSEN, MADONNA
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:WELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WOODWARD AVE # 2R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2228
Mailing Address - Country:US
Mailing Address - Phone:929-261-2326
Mailing Address - Fax:
Practice Address - Street 1:608 WOODWARD AVE # 2R
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2228
Practice Address - Country:US
Practice Address - Phone:929-261-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist