Provider Demographics
NPI:1760602080
Name:PALACE DRUG COMPANY
Entity Type:Organization
Organization Name:PALACE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:JEWELL
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-643-3231
Mailing Address - Street 1:100 N MAIN
Mailing Address - Street 2:
Mailing Address - City:RISING STAR
Mailing Address - State:TX
Mailing Address - Zip Code:76471
Mailing Address - Country:US
Mailing Address - Phone:254-643-3231
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471
Practice Address - Country:US
Practice Address - Phone:254-643-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144733Medicaid