Provider Demographics
NPI:1376209619
Name:MALAKHAM, ANYAMANEE (RPH)
Entity Type:Individual
Prefix:
First Name:ANYAMANEE
Middle Name:
Last Name:MALAKHAM
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 1:1240 LOMBARDI LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6711
Mailing Address - Country:US
Mailing Address - Phone:415-524-6838
Mailing Address - Fax:
Practice Address - Street 1:95 MONTGOMERY DR STE 108
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6638
Practice Address - Country:US
Practice Address - Phone:707-525-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH85018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist