Provider Demographics
NPI:1831288802
Name:JANET, MALCOLM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:
Last Name:JANET
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EMERALD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:714-528-3610
Mailing Address - Fax:714-528-0701
Practice Address - Street 1:41 EMERALD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614
Practice Address - Country:US
Practice Address - Phone:714-528-3610
Practice Address - Fax:714-528-0701
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH40726OtherPHARMACIST LICENCE