Healthcare Provider Details

I. General information

NPI: 1861313488
Provider Name (Legal Business Name): GINA J PALERMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 ELMHURST CT
SLIDELL LA
70458-8831
US

IV. Provider business mailing address

404 ELMHURST CT
SLIDELL LA
70458-8831
US

V. Phone/Fax

Practice location:
  • Phone: 985-590-0576
  • Fax:
Mailing address:
  • Phone: 985-590-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.016692
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: