Provider Demographics
NPI:1558592907
Name:MALONE, THOMAS WESLEY (DPH)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WESLEY
Last Name:MALONE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 BANDYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2703
Mailing Address - Country:US
Mailing Address - Phone:615-292-3359
Mailing Address - Fax:615-297-6153
Practice Address - Street 1:2134 BANDYWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2703
Practice Address - Country:US
Practice Address - Phone:615-292-3359
Practice Address - Fax:615-297-6153
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist