=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699090241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT R PALMER JR. RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2010
-----------------------------------------------------
Last Update Date | 04/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14402 FM 2100 RD
-----------------------------------------------------
City | CROSBY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77532-6570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-328-8097
-----------------------------------------------------
Fax | 281-328-8137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14402 FM 2100 RD
-----------------------------------------------------
City | CROSBY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77532-6570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-328-8097
-----------------------------------------------------
Fax | 281-328-8137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 18878
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------