Healthcare Provider Details

I. General information

NPI: 1134040421
Provider Name (Legal Business Name): MARK STEPHAN MALLONEE JR. PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 COUNTRY CLUB MALL RD
LAVALE MD
21502-7553
US

IV. Provider business mailing address

12500 COUNTRY CLUB MALL RD
LAVALE MD
21502-7553
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-5088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30840
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: