Provider Demographics
NPI:1477648467
Name:VISMAR INC
Entity Type:Organization
Organization Name:VISMAR INC
Other - Org Name:PALMER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VISCONTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-869-5700
Mailing Address - Street 1:49 LAKE AVENUE
Mailing Address - Street 2:GREENWICH MEDICAL BUILDING
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-869-5700
Mailing Address - Fax:203-869-5788
Practice Address - Street 1:49 LAKE AVENUE
Practice Address - Street 2:GREENWICH MEDICAL BUILDING
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-869-5700
Practice Address - Fax:203-869-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCY000352OtherSTATE LICENSE #
CT008044400Medicaid
NY01907886OtherNY STATE MEDICAID
CT0723153OtherNABP/NCPDP
CT0723153OtherNABP/NCPDP