Provider Demographics
NPI:1043096258
Name:HORTON, MALLORY PAIGE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:PAIGE
Last Name:HORTON
Suffix:
Gender:F
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 1:1005 INDIAN HILLS CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1327
Mailing Address - Country:US
Mailing Address - Phone:303-817-9728
Mailing Address - Fax:
Practice Address - Street 1:1760 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4850
Practice Address - Country:US
Practice Address - Phone:941-474-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66289.183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist