Provider Demographics
NPI:1194985127
Name:PALMER-RUSSELL, PATRICE ANNTOINETTE
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:ANNTOINETTE
Last Name:PALMER-RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PINECONE LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5882
Mailing Address - Country:US
Mailing Address - Phone:978-409-2440
Mailing Address - Fax:978-244-1302
Practice Address - Street 1:10 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3610
Practice Address - Country:US
Practice Address - Phone:978-244-1300
Practice Address - Fax:978-244-1302
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21259183500000X
MD09392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist