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Organization
GREGORY T LEE
Active
Organization
GREGORY T LEE
Active
Other names
PALACE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LEE (OWNER)
(601) 792-4959
Entity
Organization
Contact information
Practice address
2234 COLUMBIA AVE, PRENTISS, MS 39474-0819
(601) 792-4959
(601) 792-4003
Mailing address
PO BOX 819, PRENTISS, MS 39474-0819
(601) 792-4959
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
04377/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330448
—
MS
01
—
2043400
PK
—
Enumeration date
10/13/2006
Last updated
10/06/2016
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