Provider Demographics
NPI:1194062158
Name:PALMER, MARK HILTON
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HILTON
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 SW MARTIN HWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3373
Mailing Address - Country:US
Mailing Address - Phone:772-232-4062
Mailing Address - Fax:772-232-4067
Practice Address - Street 1:1395 SW MARTIN HWY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3373
Practice Address - Country:US
Practice Address - Phone:772-232-4062
Practice Address - Fax:772-232-4067
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist