Provider Demographics
NPI:1073830972
Name:PALMER, TINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SAWYERS MILL XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6811
Mailing Address - Country:US
Mailing Address - Phone:757-673-0623
Mailing Address - Fax:757-673-2447
Practice Address - Street 1:770 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1921
Practice Address - Country:US
Practice Address - Phone:757-627-5588
Practice Address - Fax:757-533-9412
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist