Provider Demographics
NPI:1447828140
Name:PALAZZI, MATTHEW DRAKE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DRAKE
Last Name:PALAZZI
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:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-0112
Mailing Address - Country:US
Mailing Address - Phone:501-344-2763
Mailing Address - Fax:
Practice Address - Street 1:232 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:AR
Practice Address - Zip Code:72020-8808
Practice Address - Country:US
Practice Address - Phone:501-344-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist