Provider Demographics
NPI:1265725022
Name:MALIK, RAPHAEL FREDERICK (RPH)
Entity type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:FREDERICK
Last Name:MALIK
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 1:160 EAST AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5715
Mailing Address - Country:US
Mailing Address - Phone:203-286-6466
Mailing Address - Fax:
Practice Address - Street 1:190 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1112
Practice Address - Country:US
Practice Address - Phone:203-838-6141
Practice Address - Fax:203-838-6175
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.9589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist