Provider Demographics
NPI:1881842060
Name:MALCOLM, O'NEAL T (PHARMD,RPH,CIP)
Entity Type:Individual
Prefix:DR
First Name:O'NEAL
Middle Name:T
Last Name:MALCOLM
Suffix:
Gender:M
Credentials:PHARMD,RPH,CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 CHEW AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2803
Mailing Address - Country:US
Mailing Address - Phone:215-438-4695
Mailing Address - Fax:
Practice Address - Street 1:5301 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-2803
Practice Address - Country:US
Practice Address - Phone:215-438-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist