Provider Demographics
NPI:1649308594
Name:MALONE, DONNA BULL (RPH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:BULL
Last Name:MALONE
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-0430
Mailing Address - Country:US
Mailing Address - Phone:423-626-9780
Mailing Address - Fax:423-626-5341
Practice Address - Street 1:915 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6651
Practice Address - Country:US
Practice Address - Phone:423-626-9780
Practice Address - Fax:423-626-5341
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist