Provider Demographics
NPI:1598092017
Name:MALIACKAL, SHYE GEORGE
Entity Type:Individual
Prefix:
First Name:SHYE
Middle Name:GEORGE
Last Name:MALIACKAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 TEXAS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4009
Mailing Address - Country:US
Mailing Address - Phone:281-208-3304
Mailing Address - Fax:
Practice Address - Street 1:2203 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4009
Practice Address - Country:US
Practice Address - Phone:281-208-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42225183500000X
FLPS37266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist