Provider Demographics
NPI:1548523053
Name:MALMEVIK, MICHAEL K (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:MALMEVIK
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 1:18722 48TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7725
Mailing Address - Country:US
Mailing Address - Phone:360-691-0361
Mailing Address - Fax:
Practice Address - Street 1:11401 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-7210
Practice Address - Country:US
Practice Address - Phone:360-651-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist