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General NPI Number Information
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NPI Number | 1053397950
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Entity Type | Organization
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Legal Business Name | PALACE PHARMACY
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2800 GENEVA AVE
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City | DALY CITY
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State | CA
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Zip | 94014-1523
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Country | US
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Telephone | 415-467-5232
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Fax | 415-467-5234
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Provider Business Mailing Address
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Address Line | 2800 GENEVA AVE
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City | DALY CITY
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State | CA
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Zip | 94014-1523
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Country | US
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Telephone | 415-467-5232
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Fax | 415-467-5234
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Authorized Official
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Title or Position | PHARMACIST
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Name | JOHN LC LEE
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Credential | PHARM D.
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Telephone | 415-467-5232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 29855
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License Number State | CA
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