Provider Demographics
NPI:1073675872
Name:MALKOVICH, APRYL LYNN (BS)
Entity Type:Individual
Prefix:MRS
First Name:APRYL
Middle Name:LYNN
Last Name:MALKOVICH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:4241 HIGHWAY 14 WEST
Practice Address - Street 2:REA CLINIC PHARMACY
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822
Practice Address - Country:US
Practice Address - Phone:618-724-2136
Practice Address - Fax:618-724-2571
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51033533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist