Provider Demographics
NPI:1376889899
Name:MALLETTE, JONATHAN RAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RAY
Last Name:MALLETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 N PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4504
Mailing Address - Country:US
Mailing Address - Phone:731-423-4904
Mailing Address - Fax:731-423-4914
Practice Address - Street 1:941 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4504
Practice Address - Country:US
Practice Address - Phone:731-423-4904
Practice Address - Fax:731-423-4914
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN338091835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist