MEDICARE: ANNA CHAPDELAINE MALOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	31181	TX
2	183500000X	Pharmacist	15352	OK

General Provider Information

NPI Number	:	1962748186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CHAPDELAINE MALOY

Provider Business Mailing Address
First Line	:	611 E NOBLE AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3410
Country	:	US
Telephone Number	:	937-215-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 E CLEVELAND AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3239
Country	:	US
Telephone Number	:	405-282-0466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2012
Last Update Date	:	12/15/2012

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Directions to “ ANNA CHAPDELAINE MALOY ” Practice Location

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