Organization
MALCOLMS DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY SMITH RPL (PHARMACIST/PRESIDENT)
(912) 384-1898
Entity
Organization
Contact information
Practice address
250 SOUTH PETERSON AVE, MALCOLMS DRUG STORE INC, DOUGLAS, GA 31533-5237
(912) 384-1989
(912) 383-7109
Mailing address
250 SOUTH PETERSON AVE, MALCOLMS DRUG STORE INC, DOUGLAS, GA 31533-5237
(912) 384-1989
(912) 383-7109
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHRE007080
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1109277
MEMBER HEALTH MHRX
—
Enumeration date
08/31/2006
Last updated
08/22/2020
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