Provider Demographics
NPI:1770629875
Name:PALACE DRUG STORE
Entity Type:Organization
Organization Name:PALACE DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-592-2525
Mailing Address - Street 1:131 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-3237
Mailing Address - Country:US
Mailing Address - Phone:806-592-2525
Mailing Address - Fax:806-592-3958
Practice Address - Street 1:131 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-3237
Practice Address - Country:US
Practice Address - Phone:806-592-2525
Practice Address - Fax:806-592-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy