Healthcare Provider Details

I. General information

NPI: 1366573297
Provider Name (Legal Business Name): MALKEN PHARM SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E. BACON ST
PEMBROKE GA
31321
US

IV. Provider business mailing address

P.O BOX 1329
PEMBROKE GA
31321
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-2772
  • Fax: 912-653-2752
Mailing address:
  • Phone: 912-653-2772
  • Fax: 912-653-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE005854
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH BRANT KICKLIGHTER
Title or Position: PRESIDENT/OWNER
Credential: PHARMD
Phone: 912-653-2772