Healthcare Provider Details

I. General information

NPI: 1790698959
Provider Name (Legal Business Name): MALKON GEORGE MALKON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 N 1ST AVE
EVANSVILLE IN
47710-3622
US

IV. Provider business mailing address

1570 HERNDON DR
EVANSVILLE IN
47711-4210
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-1525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: