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General NPI Number Information
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NPI Number | 1679610554
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Entity Type | Individual
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Provider Name | TIMOTHY ERIC MALMO RPH
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1399 S FRONTAGE RD
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City | HASTINGS
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State | MN
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Zip | 55033-2427
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Country | US
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Telephone | 651-437-9608
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Fax |
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Provider Business Mailing Address
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Address Line | 15579 CHERRY PATH
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City | ROSEMOUNT
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State | MN
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Zip | 55068-2586
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Country | US
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Telephone | 651-322-7351
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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 | 114670
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License Number State | MN
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