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Organization
SUNIL MALHOTRA MD LLC
Active
Organization
SUNIL MALHOTRA MD LLC
Active
Parent organization
GOOMAN MEDICAL CLINIC
Other names
GOODMAN PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOMAN MEDICAL CLINIC
Authorized official
DR. SUNIL MALHOTRA MD (OWNER/PHYSICIAN)
(662) 536-3331
Entity
Organization
Contact information
Practice address
470 GOODMAN RD E, SOUTHAVEN, MS 38671-9557
(662) 536-3331
(662) 536-3329
Mailing address
470 GOODMAN RD E, SOUTHAVEN, MS 38671-9557
(662) 536-3331
(662) 536-3329
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02909778
—
MS
Enumeration date
08/15/2016
Last updated
05/04/2017
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