# MALCOLMS DRUG STORE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043372915
- **Authorized official:** PROF. STANLEY SMITH RPH (PRESIDENT)
- **Authorized official phone:** (912) 384-1898

## Contact information

- **Practice address:** 250 PETERSON AVE S, DOUGLAS, GA 31533-5237
- **Practice address phone:** (912) 384-1898
- **Practice address fax:** (912) 383-7109
- **Mailing address:** 250 PETERSON AVE S, DOUGLAS, GA 31533-5237
- **Mailing address phone:** (912) 384-1898
- **Mailing address fax:** (912) 383-7109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE007181 | GA | Yes |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 08/22/2020