Healthcare Provider Details

I. General information

NPI: 1457529588
Provider Name (Legal Business Name): MALYKA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7836A WISE AVE
DUNDALK MD
21222-3338
US

IV. Provider business mailing address

7836A WISE AVE
DUNDALK MD
21222-3338
US

V. Phone/Fax

Practice location:
  • Phone: 410-285-8500
  • Fax: 410-285-7500
Mailing address:
  • Phone: 410-285-8500
  • Fax: 410-285-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04736
License Number StateMD

VIII. Authorized Official

Name: FAWAD SHAIKH
Title or Position: PHCY MANG
Credential:
Phone: 410-285-8500