Healthcare Provider Details

I. General information

NPI: 1598825564
Provider Name (Legal Business Name): PALMERRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 SMITH AVE
ACTON CA
93510
US

IV. Provider business mailing address

3630 SMITH AVE
ACTON CA
93510
US

V. Phone/Fax

Practice location:
  • Phone: 661-269-0054
  • Fax: 661-269-0295
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48219
License Number StateCA

VIII. Authorized Official

Name: HANNAH MASON
Title or Position: PRESIDENT
Credential: DRPH
Phone: 661-269-0054