Provider Demographics
NPI:1982942371
Name:PALMER, PAMELA (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PALMER
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 1:4081 SW SAINT LUCIE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3839
Mailing Address - Country:US
Mailing Address - Phone:772-288-1128
Mailing Address - Fax:
Practice Address - Street 1:1125 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5332
Practice Address - Country:US
Practice Address - Phone:772-335-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist