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General NPI Number Information
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NPI Number | 1265591135
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Entity Type | Organization
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Legal Business Name | PALESTINE PHARMACY LLC
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 101 MEDICAL DR
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City | PALESTINE
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State | TX
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Zip | 75801-4781
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Country | US
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Telephone | 903-729-3100
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Fax | 903-729-3104
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Provider Business Mailing Address
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Address Line | 101 MEDICAL DR
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City | PALESTINE
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State | TX
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Zip | 75801-4781
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Country | US
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Telephone | 903-729-3100
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Fax | 903-729-3104
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MR. GEORGE LAYNE VANNOY
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Credential | RPH
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Telephone | 903-729-3100
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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 | 4536655
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License Number State | TX
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