Provider Demographics
NPI:1255812723
Name:MALONE, BRYCESON G II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYCESON
Middle Name:G
Last Name:MALONE
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 BAYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-9548
Mailing Address - Country:US
Mailing Address - Phone:859-537-4881
Mailing Address - Fax:
Practice Address - Street 1:191 CARL ELLER RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-6262
Practice Address - Country:US
Practice Address - Phone:828-689-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist