Provider Demographics
NPI:1588953269
Name:MALZAHN, CRAIG (PHARM D)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MALZAHN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3691
Mailing Address - Country:US
Mailing Address - Phone:530-662-1795
Mailing Address - Fax:
Practice Address - Street 1:295 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3691
Practice Address - Country:US
Practice Address - Phone:530-662-1795
Practice Address - Fax:530-662-6261
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist