Provider Demographics
NPI:1184891095
Name:PALMATIER, KELLY ANN (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:PALMATIER
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 1:164 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-4114
Mailing Address - Country:US
Mailing Address - Phone:607-967-3004
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1139
Practice Address - Country:US
Practice Address - Phone:607-563-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist