Healthcare Provider Details

I. General information

NPI: 1922584150
Provider Name (Legal Business Name): MALONE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 10TH ST
MALONE FL
32445-3128
US

IV. Provider business mailing address

PO BOX 94
MALONE FL
32445-0094
US

V. Phone/Fax

Practice location:
  • Phone: 850-569-5100
  • Fax: 850-569-5170
Mailing address:
  • Phone: 850-569-5100
  • Fax: 850-569-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT EUGENE JENNINGS JR.
Title or Position: MANAGER/MEMBER
Credential: PHARM, D.
Phone: 850-569-5100