Healthcare Provider Details

I. General information

NPI: 1023393220
Provider Name (Legal Business Name): DAVID MICHAEL MALENOWSKI I PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MILLER TRUNK HWY
DULUTH MN
55811-5633
US

IV. Provider business mailing address

9307 PEQUAYWAN LAKE RD
DULUTH MN
55803-9767
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-8157
  • Fax: 218-727-4261
Mailing address:
  • Phone: 218-848-8077
  • Fax: 218-727-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number117740
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: