Provider Demographics
NPI:1477993822
Name:MALLOY, JOSEPH JOHN III
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:MALLOY
Suffix:III
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:JOHN
Other - Last Name:MALLOY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1325 EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0774
Mailing Address - Country:US
Mailing Address - Phone:209-383-1972
Mailing Address - Fax:
Practice Address - Street 1:1325 EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0774
Practice Address - Country:US
Practice Address - Phone:209-383-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist