Healthcare Provider Details

I. General information

NPI: 1316681562
Provider Name (Legal Business Name): PALMETTO INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 BRECKINRIDGE BLVD STE 126
DULUTH GA
30096-4989
US

IV. Provider business mailing address

PO BOX 538476
ATLANTA GA
30353-8476
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 800-809-1265
  • Fax: 866-872-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GLENN EUGENE RICHMOND
Title or Position: SR. DIRECTOR
Credential: RN
Phone: 843-314-2060