Provider Demographics
NPI:1316251184
Name:MALOOF, DANIEL M
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:MALOOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2338
Mailing Address - Country:US
Mailing Address - Phone:508-965-1795
Mailing Address - Fax:
Practice Address - Street 1:655 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1404
Practice Address - Country:US
Practice Address - Phone:401-434-5700
Practice Address - Fax:401-438-5639
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03690183500000X
MAPH22727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist