Organization
PALACE DRUG OF COALGATE LLC
Active
Other names
Palace Drug
Organization subpart
No
Provider details
NPI number
Authorized official
JARED COLLINS (OWNER)
(580) 927-2064
Entity
Organization
Contact information
Practice address
104 W OHIO AVE, COALGATE, OK 74538-2827
(580) 927-2064
(580) 927-2508
Mailing address
PO BOX 273, COALGATE, OK 74538-0273
(580) 927-2064
(580) 927-2508
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
74-7690
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100233410A
—
OK
01
—
2072710
PK
—
Enumeration date
10/23/2006
Last updated
10/07/2021
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