MEDICARE: DONNA BULL MALONE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5151	TN

General Provider Information

NPI Number	:	1649308594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA BULL MALONE RPH

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	TAZEWELL
State	:	TN
Zip	:	37879-0430
Country	:	US
Telephone Number	:	423-626-9780
Fax Number	:	423-626-5341

Provider Business Practice Location Address
First Line	:	915 MAIN ST
Second Line	:
City	:	NEW TAZEWELL
State	:	TN
Zip	:	37825-6651
Country	:	US
Telephone Number	:	423-626-9780
Fax Number	:	423-626-5341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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