Provider Demographics
NPI:1619002805
Name:MALONEY, DAVID WILLIAM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:MALONEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:764 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7643
Mailing Address - Country:US
Mailing Address - Phone:559-322-7660
Mailing Address - Fax:559-322-7660
Practice Address - Street 1:1506 DRAPER ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1909
Practice Address - Country:US
Practice Address - Phone:559-897-5111
Practice Address - Fax:559-897-1926
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25331261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25331Medicaid
CA25331Medicare ID - Type Unspecified
CA25331Medicare UPIN