Provider Demographics
NPI:1093096810
Name:PALMVILLE PHARMACY
Entity Type:Organization
Organization Name:PALMVILLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADESHINA
Authorized Official - Middle Name:SHON
Authorized Official - Last Name:BAMIGBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-547-7600
Mailing Address - Street 1:799 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8909
Mailing Address - Country:US
Mailing Address - Phone:718-547-7600
Mailing Address - Fax:
Practice Address - Street 1:799 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-547-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030932333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy