Provider Demographics
NPI:1336249309
Name:PALMER PHARMACY INC
Entity Type:Organization
Organization Name:PALMER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:315-730-0534
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886
Mailing Address - Country:US
Mailing Address - Phone:607-387-6728
Mailing Address - Fax:607-387-7045
Practice Address - Street 1:2083 RT 96
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886
Practice Address - Country:US
Practice Address - Phone:607-387-6728
Practice Address - Fax:607-387-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026807333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587960Medicaid
3340318OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5256730001Medicare NSC