Provider Demographics
NPI:1487138319
Name:MADON, JAMES ROBERT III (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MADON
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1263
Mailing Address - Country:US
Mailing Address - Phone:270-237-5402
Mailing Address - Fax:
Practice Address - Street 1:202 S COURT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1263
Practice Address - Country:US
Practice Address - Phone:270-237-5402
Practice Address - Fax:270-237-4035
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41204183500000X
KY019369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist