Provider Demographics
NPI:1073957346
Name:MALTBY, PATRICIA GAIL (RPH)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:GAIL
Last Name:MALTBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 187
Mailing Address - Street 2:900 MAIN ST
Mailing Address - City:BROWNSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53006
Mailing Address - Country:US
Mailing Address - Phone:920-583-1310
Mailing Address - Fax:920-583-3741
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53006
Practice Address - Country:US
Practice Address - Phone:920-583-1310
Practice Address - Fax:920-583-3741
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9419-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist