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General NPI Number Information
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NPI Number | 1417830795
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Entity Type | Individual
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Provider Name | MALEEK DEVONTE MONTGOMERY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 770-918-3572
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Fax |
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Provider Business Mailing Address
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Address Line | 157 LONGVIEW RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-2627
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Country | US
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Telephone | 770-412-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH035638
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License Number State | GA
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