Provider Demographics
NPI:1306806377
Name:PACE, MALCOLM AMOS (RPH)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:AMOS
Last Name:PACE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3529
Mailing Address - Country:US
Mailing Address - Phone:540-857-7600
Mailing Address - Fax:540-857-6946
Practice Address - Street 1:515 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3529
Practice Address - Country:US
Practice Address - Phone:540-857-7600
Practice Address - Fax:540-857-6946
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist