Provider Demographics
NPI:1386630812
Name:MALONE, DAVID T (DPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:MALONE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 TERRELL LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7862
Mailing Address - Country:US
Mailing Address - Phone:606-546-9241
Mailing Address - Fax:606-546-6992
Practice Address - Street 1:297 TERRELL LN
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7862
Practice Address - Country:US
Practice Address - Phone:606-546-9241
Practice Address - Fax:606-546-6992
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7776183500000X
KY010730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist