Provider Demographics
NPI:1962748186
Name:MALOY, ANNA CHAPDELAINE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CHAPDELAINE
Last Name:MALOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3410
Mailing Address - Country:US
Mailing Address - Phone:937-215-4107
Mailing Address - Fax:
Practice Address - Street 1:220 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3239
Practice Address - Country:US
Practice Address - Phone:405-282-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31181183500000X
OK15352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist