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General NPI Number Information
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NPI Number | 1487577078
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Entity Type | Organization
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Legal Business Name | MALLORY'S MODERN MEDICINE, LLC
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/01/2026
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Provider Practice Location Address
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Address Line | 141 W BANKHEAD ST
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City | NEW ALBANY
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State | MS
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Zip | 38652-3314
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Country | US
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Telephone | 662-486-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 141 W BANKHEAD ST
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City | NEW ALBANY
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State | MS
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Zip | 38652-3314
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Country | US
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Telephone | 662-486-2150
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Fax |
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Authorized Official
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Title or Position | OWNER/COMPOUNDING PHARMACIST
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Name | MALLORY BEATY
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Credential | PHARMD, BCSCP
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Telephone | 662-316-5021
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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 |
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License Number State |
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