Provider Demographics
NPI:1942792247
Name:PALACE DRUG STORE OF COLBY LLC
Entity Type:Organization
Organization Name:PALACE DRUG STORE OF COLBY LLC
Other - Org Name:PALACE DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYSHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-460-7507
Mailing Address - Street 1:460 N FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2326
Mailing Address - Country:US
Mailing Address - Phone:785-460-7507
Mailing Address - Fax:785-460-2522
Practice Address - Street 1:460 N FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2326
Practice Address - Country:US
Practice Address - Phone:785-460-7507
Practice Address - Fax:785-460-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-1057163336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2-105716OtherKANSAS STATE BOARD OF PHARMACY