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General NPI Number Information
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NPI Number | 1083614697
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Entity Type | Organization
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Legal Business Name | PALACE DRUG STORE INC
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 460 N FRANKLIN AVE
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City | COLBY
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State | KS
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Zip | 67701-2326
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Country | US
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Telephone | 785-460-7507
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Fax | 785-460-2522
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Provider Business Mailing Address
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Address Line | 460 N FRANKLIN AVE
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City | COLBY
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State | KS
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Zip | 67701-2326
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Country | US
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Telephone | 785-460-7507
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Fax | 785-460-2522
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. RANDALL DUANE SMITH
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Credential | RPH.
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Telephone | 785-460-7507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2-06543
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 2-06543
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 206543
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License Number State | KS
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