Provider Demographics
NPI:1649544651
Name:MALLCHOK, HARRY (RPH)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:MALLCHOK
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 1:536 EMPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3564
Mailing Address - Country:US
Mailing Address - Phone:541-514-0123
Mailing Address - Fax:
Practice Address - Street 1:650 Q ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2353
Practice Address - Country:US
Practice Address - Phone:541-741-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist