MEDICARE: PALMETTO INFUSION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1316681562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO INFUSION SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 538476
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8476
Country	:	US
Telephone Number	:	843-314-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 BRECKINRIDGE BLVD STE 126
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4989
Country	:	US
Telephone Number	:	800-809-1265
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GLENN EUGENE RICHMOND
Credential	:
Telephone Number	:	843-314-2060

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/15/2025

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