Provider Demographics
NPI:1528588944
Name:SENGSAMOUTH-TROUT, MALISSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:
Last Name:SENGSAMOUTH-TROUT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6575 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3703
Mailing Address - Country:US
Mailing Address - Phone:251-370-9848
Mailing Address - Fax:251-370-9849
Practice Address - Street 1:6575 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3703
Practice Address - Country:US
Practice Address - Phone:251-370-9848
Practice Address - Fax:251-370-9849
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist