Provider Demographics
NPI:1437464245
Name:MALINOWSKI, MIKE THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:THOMAS
Last Name:MALINOWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15222 LOCKETT LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-8381
Mailing Address - Country:US
Mailing Address - Phone:225-588-9216
Mailing Address - Fax:
Practice Address - Street 1:12881 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1913
Practice Address - Country:US
Practice Address - Phone:225-763-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist