Provider Demographics
NPI:1801013289
Name:PALMER, JOE ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ANTHONY
Last Name:PALMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 VERMONT RD
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-3193
Mailing Address - Country:US
Mailing Address - Phone:618-985-8424
Mailing Address - Fax:
Practice Address - Street 1:709 VERMONT RD
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-3193
Practice Address - Country:US
Practice Address - Phone:618-985-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist