Provider Demographics
NPI:1356194112
Name:PALMER PHARMACY LLC
Entity type:Organization
Organization Name:PALMER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-265-1632
Mailing Address - Street 1:738 LITTLE DEER CREEK VALLEY ROAD
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076
Mailing Address - Country:US
Mailing Address - Phone:724-265-1632
Mailing Address - Fax:724-265-1120
Practice Address - Street 1:738 LITTLE DEER CREEK VALLEY RD
Practice Address - Street 2:
Practice Address - City:RUSSELLTON
Practice Address - State:PA
Practice Address - Zip Code:15076-1333
Practice Address - Country:US
Practice Address - Phone:724-265-1632
Practice Address - Fax:724-265-1120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMER PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy