Provider Demographics
NPI:1952469462
Name:PHILLIPS-MALCOM, CHRISTY B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:B
Last Name:PHILLIPS-MALCOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FRANKLIN SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-4109
Mailing Address - Country:US
Mailing Address - Phone:706-245-7223
Mailing Address - Fax:706-245-6727
Practice Address - Street 1:26 FRANKLIN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-4109
Practice Address - Country:US
Practice Address - Phone:706-245-7223
Practice Address - Fax:706-245-6727
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0371500001Medicare ID - Type Unspecified