Provider Demographics
NPI:1437587342
Name:PALMER, KIRSTEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:
Last Name:PALMER
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 1:322 N WICKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2935
Mailing Address - Country:US
Mailing Address - Phone:318-470-6400
Mailing Address - Fax:318-746-1051
Practice Address - Street 1:5590 BARKSDALE BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-8703
Practice Address - Country:US
Practice Address - Phone:318-746-1718
Practice Address - Fax:318-746-1051
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist