Active NPI
Daniel Russ Malcom, PHARM.D.
- Pharmacist
- Louisville, KY
National Provider Identifier
1407145790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 015112
- Practice address
- 2100 Gardiner LN
Louisville, KY 40205-2962 - Phone
- (502) 413-8969
- NPI assigned
- Apr 7, 2011
- Last updated
- Apr 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 015112 | KY | Primary |
| Pharmacist | 183500000X | RPH024223 | GA |
Addresses
Primary practice location
2100 Gardiner LN
Louisville, KY 40205-2962
Mailing address
2100 Gardiner LN
Louisville, KY 40205-2962
Phone (502) 413-8969
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH024223 | GA | MD | Pharmacist |
| 015112 | KY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302134400000",
"number": "1407145790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 GARDINER LN",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402052962",
"telephone_number": "502-413-8969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 GARDINER LN",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402052962",
"telephone_number": "502-413-8969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOM",
"first_name": "DANIEL",
"middle_name": "RUSS",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-07",
"last_updated": "2011-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "015112",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH024223",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.