Provider Demographics
NPI:1619719085
Name:PEACH-KEEN, MADISON ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:ELIZABETH
Last Name:PEACH-KEEN
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 1:3715 E OVERLAND RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8301
Mailing Address - Country:US
Mailing Address - Phone:803-727-8659
Mailing Address - Fax:
Practice Address - Street 1:3715 E OVERLAND RD STE 115
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8301
Practice Address - Country:US
Practice Address - Phone:803-727-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist