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General NPI Number Information
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NPI Number | 1003620972
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Entity Type | Organization
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Legal Business Name | PALACE DRUG OF SALEM LLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 106 HIGHWAY 62 W
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City | SALEM
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State | AR
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Zip | 72576-8059
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Country | US
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Telephone | 870-895-3811
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Fax | 870-895-3836
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | MAMMOTH SPRING
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State | AR
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Zip | 72554-0007
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Country | US
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Telephone | 870-625-3222
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY OPERATIONS
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Name | SARAH CLARK
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Credential |
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Telephone | 870-625-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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