Provider Demographics
NPI:1932454519
Name:MALETICH, PHILLIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MALETICH
Suffix:
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 1:8329 COAL BANK RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645-9730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8329 COAL BANK RD
Practice Address - Street 2:
Practice Address - City:MARSHALLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44645-9730
Practice Address - Country:US
Practice Address - Phone:330-855-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03131919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist