MEDICARE: PALMER PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	017538	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3374713	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548286404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMER PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	OVID
State	:	NY
Zip	:	14521-0369
Country	:	US
Telephone Number	:	607-869-5033
Fax Number	:	607-869-5252

Provider Business Practice Location Address
First Line	:	7115 N MAIN ST
Second Line	:
City	:	OVID
State	:	NY
Zip	:	14521
Country	:	US
Telephone Number	:	607-869-5033
Fax Number	:	607-869-5252

Authorized Official
Title or Position	:	OWNER CEO
Name	:	MR. DARREN JAMES PALMER
Credential	:
Telephone Number	:	315-730-0534

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/19/2009

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Directions to “PALMER PHARMACY INC ” Practice Location

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