Provider Demographics
NPI:1255454815
Name:MALCOM, REX C (PHARM D, DMD)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:C
Last Name:MALCOM
Suffix:
Gender:M
Credentials:PHARM D, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 DEBARR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1706
Mailing Address - Country:US
Mailing Address - Phone:907-337-0404
Mailing Address - Fax:
Practice Address - Street 1:6611 DEBARR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1706
Practice Address - Country:US
Practice Address - Phone:907-337-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1523183500000X
AK100531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist