Provider Demographics
NPI:1750402855
Name:MALINOWSKI, SCOTT STANLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STANLEY
Last Name:MALINOWSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-2055
Mailing Address - Fax:601-984-2063
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:CARDIOLOGY - HEART FAILURE DISEASE MANAGEMENT CLINIC
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-815-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-08453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist