Provider Demographics
NPI:1134429574
Name:MALLOZZI, ANTHONY PETER (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PETER
Last Name:MALLOZZI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9322
Mailing Address - Country:US
Mailing Address - Phone:606-673-4427
Mailing Address - Fax:606-673-4804
Practice Address - Street 1:275 WALTON DR
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9322
Practice Address - Country:US
Practice Address - Phone:606-673-4427
Practice Address - Fax:606-673-4804
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015125183500000X
NY031284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist