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General NPI Number Information
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NPI Number | 1730040189
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Entity Type | Organization
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Legal Business Name | THE PALACE CORPORATE OFFICE & WAREHOUSE
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1122 LADY ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3218
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Country | US
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Telephone | 803-995-2153
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Fax | 803-995-2153
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Provider Business Mailing Address
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Address Line | 1122 LADY ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3218
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Country | US
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Telephone | 803-995-2153
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Fax | 803-995-2153
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Authorized Official
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Title or Position | CEO, CORPORATE EXECUTIVE OFFICER
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Name | TARA KAY MARTIN
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Credential | CPA, EA, PTIN
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Telephone | 803-995-2153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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