Provider Demographics
NPI:1497280218
Name:MALONE, DENNIS ALFRED JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALFRED
Last Name:MALONE
Suffix:JR
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 1:211 RAMSLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1031
Mailing Address - Country:US
Mailing Address - Phone:608-306-2916
Mailing Address - Fax:
Practice Address - Street 1:211 RAMSLAND ST
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-1031
Practice Address - Country:US
Practice Address - Phone:608-306-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13017-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist