Provider Demographics
NPI:1639772338
Name:MALLUK, DANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:MALLUK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 LA PUERTA DEL SOL BLVD S APT 178
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1414
Mailing Address - Country:US
Mailing Address - Phone:201-657-1957
Mailing Address - Fax:
Practice Address - Street 1:2708 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1837
Practice Address - Country:US
Practice Address - Phone:813-932-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS613361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist