Provider Demographics
NPI:1558997080
Name:MALYALA, JYOTHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:MALYALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CROSSWINDS LN
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1381
Mailing Address - Country:US
Mailing Address - Phone:607-379-9156
Mailing Address - Fax:
Practice Address - Street 1:300 BYPASS 25 NE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3009
Practice Address - Country:US
Practice Address - Phone:864-321-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist