Provider Demographics
NPI:1801415500
Name:MALOLETKO, ELENA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MALOLETKO
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 1:2611 N STOWELL AVE APT E
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4222
Mailing Address - Country:US
Mailing Address - Phone:309-550-1174
Mailing Address - Fax:
Practice Address - Street 1:2611 N STOWELL AVE APT E
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4222
Practice Address - Country:US
Practice Address - Phone:309-550-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19817-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty