Provider Demographics
NPI:1689958993
Name:MALLORY, NATOHYA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATOHYA
Middle Name:
Last Name:MALLORY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NATOHYA
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:655 W 8TH ST
Mailing Address - Street 2:INTERNAL MEDICINE, ACC BUILDING-1ST FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-6268
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:INTERNAL MEDICINE, ACC BUILDING-1ST FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 449101835P0018X
TN00000331571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist