Provider Demographics
NPI:1891872024
Name:MAL ENTERPRISES, INC. DBA LAWRENCE BROS. PHARM. # 1401
Entity Type:Organization
Organization Name:MAL ENTERPRISES, INC. DBA LAWRENCE BROS. PHARM. # 1401
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-236-6351
Mailing Address - Street 1:P.O. BOX 8
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556
Mailing Address - Country:US
Mailing Address - Phone:325-236-6351
Mailing Address - Fax:325-236-6336
Practice Address - Street 1:302 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567
Practice Address - Country:US
Practice Address - Phone:325-754-1111
Practice Address - Fax:325-754-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24134183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty