Provider Demographics
NPI:1619289840
Name:MALMSTROM, ROYD E
Entity Type:Individual
Prefix:
First Name:ROYD
Middle Name:E
Last Name:MALMSTROM
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 1:9611 SOUTHWARD CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-3220
Mailing Address - Country:US
Mailing Address - Phone:512-263-2296
Mailing Address - Fax:512-329-5478
Practice Address - Street 1:701 S HIGHWAY LOOP 360
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5243
Practice Address - Country:US
Practice Address - Phone:512-329-5184
Practice Address - Fax:512-329-5478
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist