Provider Demographics
NPI:1467330779
Name:PIKE, MADISON JADE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:JADE
Last Name:PIKE
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 1:701 W VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6243
Mailing Address - Country:US
Mailing Address - Phone:208-329-4729
Mailing Address - Fax:
Practice Address - Street 1:701 W VILLAGE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6243
Practice Address - Country:US
Practice Address - Phone:208-329-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6671779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist