Provider Demographics
NPI:1518380906
Name:MALGE, PRANJALI (RPH)
Entity Type:Individual
Prefix:
First Name:PRANJALI
Middle Name:
Last Name:MALGE
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 1:1913 W HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5168
Mailing Address - Country:US
Mailing Address - Phone:480-668-9512
Mailing Address - Fax:
Practice Address - Street 1:240 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6107
Practice Address - Country:US
Practice Address - Phone:480-668-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist