Healthcare Provider Details

I. General information

NPI: 1982430559
Provider Name (Legal Business Name): DENNIS REUBEN PALNIKOV PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

8775 W TILLAMOOK DR
BOISE ID
83709-5876
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5252
  • Fax:
Mailing address:
  • Phone: 208-899-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number8861268
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: