Provider Demographics
NPI:1568613206
Name:DEPALMA, JENNIFER A (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DEPALMA
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 1:95 OLD COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514
Mailing Address - Country:US
Mailing Address - Phone:516-739-1978
Mailing Address - Fax:516-739-0985
Practice Address - Street 1:95 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1800
Practice Address - Country:US
Practice Address - Phone:516-739-1978
Practice Address - Fax:516-739-0985
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY46704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02717751Medicaid