Provider Demographics
NPI:1902406382
Name:PEARSON, MALLORY ANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANNE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 LAKEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:IN
Mailing Address - Zip Code:46118-9373
Mailing Address - Country:US
Mailing Address - Phone:812-229-3124
Mailing Address - Fax:
Practice Address - Street 1:2150 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2831
Practice Address - Country:US
Practice Address - Phone:812-443-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022794A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist