Provider Demographics
NPI:1235140724
Name:MAL ENTERPRISES INC
Entity Type:Organization
Organization Name:MAL ENTERPRISES INC
Other - Org Name:SERENITY PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER-CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:235-236-6351
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-0008
Mailing Address - Country:US
Mailing Address - Phone:325-236-6351
Mailing Address - Fax:325-236-6336
Practice Address - Street 1:507 S. BURLESON AVE.
Practice Address - Street 2:
Practice Address - City:MCCAMEY
Practice Address - State:TX
Practice Address - Zip Code:79752
Practice Address - Country:US
Practice Address - Phone:325-884-2579
Practice Address - Fax:325-884-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX267243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123721OtherPK
TX466659Medicaid