# MALLEX CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Medicine Shoppe Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023363025
- **Authorized official:** ETHAN VANDERSAND (PRESIDENT)
- **Authorized official phone:** (618) 498-6461

## Contact information

- **Practice address:** 400A W CARPENTER ST, JERSEYVILLE, IL 62052-2522
- **Practice address phone:** (618) 498-6461
- **Practice address fax:** (618) 639-9450
- **Mailing address:** 400A W CARPENTER ST, JERSEYVILLE, IL 62052-2522
- **Mailing address phone:** (618) 498-6461
- **Mailing address fax:** (618) 639-9450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054.018000 | IL | Yes |

## Other

- **Enumeration date:** 07/17/2012
- **Last updated:** 07/05/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2137095 | PK | — |