Provider Demographics
NPI:1609477835
Name:PALUMBO, ROY WALTER III
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:WALTER
Last Name:PALUMBO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436-9748
Mailing Address - Country:US
Mailing Address - Phone:330-509-8823
Mailing Address - Fax:
Practice Address - Street 1:1116 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:LOWELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44436-9748
Practice Address - Country:US
Practice Address - Phone:330-509-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist