Provider Demographics
NPI:1750462636
Name:MALLEYS INC
Entity Type:Organization
Organization Name:MALLEYS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIRCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-943-9173
Mailing Address - Street 1:1906 GEORGE WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-943-9173
Mailing Address - Fax:509-946-1122
Practice Address - Street 1:1906 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-943-9173
Practice Address - Fax:509-946-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000030553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA158229OtherLH
WA6010029Medicaid
4900494OtherNABP
WA5100310001Medicare NSC