Provider Demographics
NPI:1962647941
Name:PALMER, TIFFANY D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:D
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PINE BARK TRL
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-4203
Mailing Address - Country:US
Mailing Address - Phone:850-321-2482
Mailing Address - Fax:
Practice Address - Street 1:83 PINE BARK TRL
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-4203
Practice Address - Country:US
Practice Address - Phone:850-321-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist