Provider Demographics
NPI:1649523135
Name:PALMER, MICHAEL JOHN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
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 1:112 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-9466
Mailing Address - Country:US
Mailing Address - Phone:530-534-5348
Mailing Address - Fax:
Practice Address - Street 1:2445 ORO DAM BLVD E
Practice Address - Street 2:SUITE 9
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6035
Practice Address - Country:US
Practice Address - Phone:503-532-9555
Practice Address - Fax:530-532-1436
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist