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General NPI Number Information
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NPI Number | 1477823474
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Entity Type | Organization
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Legal Business Name | PALM MEDICINE INC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 2711 E ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4941
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Country | US
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Telephone | 954-532-7940
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Fax | 954-876-1286
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Provider Business Mailing Address
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Address Line | 2711 E ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4941
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Country | US
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Telephone | 954-532-7940
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Fax | 954-876-1286
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Authorized Official
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Title or Position | OWNER/ PHARMACIST
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Name | ROBERT SHAHNAZARIAN
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Credential |
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Telephone | 954-336-9097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25870
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License Number State | FL
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