Provider Demographics
NPI:1548286404
Name:PALMER PHARMACY INC
Entity type:Organization
Organization Name:PALMER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-730-0534
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521-0369
Mailing Address - Country:US
Mailing Address - Phone:607-869-5033
Mailing Address - Fax:607-869-5252
Practice Address - Street 1:7115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521
Practice Address - Country:US
Practice Address - Phone:607-869-5033
Practice Address - Fax:607-869-5252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMER PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NY017538333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3374713OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02869607Medicaid
NY5256730002Medicare NSC