Provider Demographics
NPI:1174684245
Name:PALMER PHARMACY PLUS INC
Entity Type:Organization
Organization Name:PALMER PHARMACY PLUS INC
Other - Org Name:PALMER PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHU
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:214-765-9238
Mailing Address - Street 1:2730 N STEMMONS FWY
Mailing Address - Street 2:SUITE 813
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2279
Mailing Address - Country:US
Mailing Address - Phone:214-765-9238
Mailing Address - Fax:214-765-9240
Practice Address - Street 1:2731 W NORTHWEST HWY
Practice Address - Street 2:STE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4788
Practice Address - Country:US
Practice Address - Phone:214-765-9238
Practice Address - Fax:214-765-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
TX230193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145097Medicaid
2096084OtherPK