Provider Demographics
NPI:1902112550
Name:PALAFOX, PATRICIA M
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:PALAFOX
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 1:550 MYRTLE AVE
Mailing Address - Street 2:ACME PHARMACY
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1914
Mailing Address - Country:US
Mailing Address - Phone:973-402-4330
Mailing Address - Fax:973-402-4335
Practice Address - Street 1:550 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1914
Practice Address - Country:US
Practice Address - Phone:973-402-4335
Practice Address - Fax:973-402-4335
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02514700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist