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General NPI Number Information
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NPI Number | 1043372915
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Entity Type | Organization
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Legal Business Name | MALCOLMS DRUG STORE INC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 250 PETERSON AVE S
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City | DOUGLAS
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State | GA
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Zip | 31533-5237
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Country | US
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Telephone | 912-384-1898
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Fax | 912-383-7109
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Provider Business Mailing Address
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Address Line | 250 PETERSON AVE S
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City | DOUGLAS
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State | GA
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Zip | 31533-5237
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Country | US
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Telephone | 912-384-1898
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Fax | 912-383-7109
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Authorized Official
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Title or Position | PRESIDENT
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Name | PROF. STANLEY SMITH
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Credential | RPH
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Telephone | 912-384-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE007181
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License Number State | GA
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