Individual
OTIS LEN MALONE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
700 W PARK AVE, GREENWOOD, MS 38930-2910
(662) 451-1121
(662) 451-1424
Mailing address
700 W PARK AVE, GREENWOOD, MS 38930-2910
(662) 451-1121
(662) 451-1424
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-15631
MS
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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