Provider Demographics
NPI:1568124634
Name:PALUGA, MALLORY (RPH)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:PALUGA
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 1:3841 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9330
Mailing Address - Country:US
Mailing Address - Phone:614-836-8420
Mailing Address - Fax:
Practice Address - Street 1:3841 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9330
Practice Address - Country:US
Practice Address - Phone:614-836-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist