Provider Demographics
NPI:1174124028
Name:THORNTON, MALENDIA HITE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MALENDIA
Middle Name:HITE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4704
Mailing Address - Country:US
Mailing Address - Phone:662-624-2523
Mailing Address - Fax:662-624-9984
Practice Address - Street 1:1000 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4704
Practice Address - Country:US
Practice Address - Phone:662-624-2523
Practice Address - Fax:662-624-9984
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist