Healthcare Provider Details

I. General information

NPI: 1427296607
Provider Name (Legal Business Name): LISA D MALLOW RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN ST
FRANKLIN WV
26807
US

IV. Provider business mailing address

203 N MAIN ST
FRANKLIN WV
26807
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2887
  • Fax: 304-358-3149
Mailing address:
  • Phone: 304-358-2887
  • Fax: 304-358-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4387
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: