Provider Demographics
NPI:1326312836
Name:MALLOY, WILLIAM XAVIER (MS, PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:XAVIER
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MS, PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 TORBAY CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9659
Mailing Address - Country:US
Mailing Address - Phone:317-417-0342
Mailing Address - Fax:
Practice Address - Street 1:7590 TORBAY CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-9659
Practice Address - Country:US
Practice Address - Phone:317-417-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013603A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist