Provider Demographics
NPI:1497028377
Name:PALMER, SANDRA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
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 1:19200 SW MARTINAZZI AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6357
Mailing Address - Country:US
Mailing Address - Phone:503-691-4233
Mailing Address - Fax:
Practice Address - Street 1:19200 SW MARTINAZZI AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6357
Practice Address - Country:US
Practice Address - Phone:503-691-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist