Individual
DR. KELLY J MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
600 COURT ST, FULTON, MO 65251-1903
(573) 642-6892
Mailing address
4201 GLADDEN LN, COLUMBIA, MO 65202-1939
(573) 814-9686
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2012026455
MO
Other
Enumeration date
03/05/2013
Last updated
03/05/2013
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