Healthcare Provider Details

I. General information

NPI: 1184766289
Provider Name (Legal Business Name): MARCIA A PALMER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MURVIHILL RD
VALPARAISO IN
46383-5960
US

IV. Provider business mailing address

1514 CARDINAL CT
MUNSTER IN
46321-3801
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-7055
  • Fax: 219-464-3111
Mailing address:
  • Phone: 219-730-7777
  • Fax: 219-924-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26013163
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51-030655
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9301
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: