Healthcare Provider Details

I. General information

NPI: 1376775288
Provider Name (Legal Business Name): MICHAEL JOHN PALLADINO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST SUITE 2260
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

111 S 11TH ST SUITE 2260
PHILADELPHIA PA
19107-4824
US

V. Phone/Fax

Practice location:
  • Phone: 215-200-6121
  • Fax: 215-503-2203
Mailing address:
  • Phone: 215-200-6121
  • Fax: 215-503-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP441344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: