Provider Demographics
NPI:1437299856
Name:MALLEY, LAUREL (RPH)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:MALLEY
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 1:20144 PINEVILLE RD STE F
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3237
Mailing Address - Country:US
Mailing Address - Phone:228-822-9868
Mailing Address - Fax:228-822-2312
Practice Address - Street 1:20144 PINEVILLE RD STE F
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3237
Practice Address - Country:US
Practice Address - Phone:228-822-9868
Practice Address - Fax:228-822-2312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST08613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist