Provider Information for 1588779136
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RALLS ENTERPRISES INC
Other Names:Doing Business As:PALACE DRUGOrganization Subpart: NO
NPI: 1588779136
Last Updated: 2021-07-20
Certification Date: 2021-07-20
Certification Date: 2021-07-20
Details
Name | Value | ||||||||||||
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NPI | 1588779136 | ||||||||||||
Enumeration Date | 2006-08-21 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: W A RALLS Title: OWNER Phone: 5802862190 | ||||||||||||
Mailing Address | 1200 SE LINCOLN RD IDABEL, OK 74745-7358 United States Phone: 580-286-2190 | Fax:580-286-5260 | ||||||||||||
Primary Practice Address | 1200 SE LINCOLN RD IDABEL, OK 74745-7358 United States Phone: 580-286-2190 | Fax:580-286-5260 | ||||||||||||
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