Provider Demographics
NPI:1609180454
Name:MALONE, PAMELA TODD
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:TODD
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6488 FM 775
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5605
Mailing Address - Country:US
Mailing Address - Phone:830-779-3730
Mailing Address - Fax:830-779-4190
Practice Address - Street 1:6488 FM 775
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5605
Practice Address - Country:US
Practice Address - Phone:830-779-3730
Practice Address - Fax:830-779-4190
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist