Provider Demographics
NPI:1447809207
Name:PALUMBO, NICHOLAS ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S WALNUT ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2845
Mailing Address - Country:US
Mailing Address - Phone:765-729-9661
Mailing Address - Fax:
Practice Address - Street 1:1501 E 29TH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5890
Practice Address - Country:US
Practice Address - Phone:765-282-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028003A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist