Provider Demographics
NPI:1922584150
Name:MALONE PHARMACY LLC
Entity Type:Organization
Organization Name:MALONE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM, D
Authorized Official - Phone:850-569-5100
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-0094
Mailing Address - Country:US
Mailing Address - Phone:850-569-5100
Mailing Address - Fax:850-569-5170
Practice Address - Street 1:5404 10TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3128
Practice Address - Country:US
Practice Address - Phone:850-569-5100
Practice Address - Fax:850-569-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy