Provider Demographics
NPI:1235578105
Name:PALMORE, SAMANTHA
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:PALMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-2714
Mailing Address - Country:US
Mailing Address - Phone:870-898-5151
Mailing Address - Fax:870-898-2395
Practice Address - Street 1:191 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-2714
Practice Address - Country:US
Practice Address - Phone:870-898-5151
Practice Address - Fax:870-898-2395
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist