Basic Information
| Provider Information | |||||||||
| NPI: | 1033685383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAUDLE | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 EVESHAM DR | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294855847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439063973 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 389 JOHNNIE DODDS BLVD | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294642932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439724068 | ||||||||
| FaxNumber: | 8439724069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2018 | ||||||||
| LastUpdateDate: | 10/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 37415 | SC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.