Gregory T Lee

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

04377/1.1 Issued in MS

Legal business name

GREGORY T LEE

Doing business as

Palace Drug Store

Practice address

2234 Columbia Ave
Prentiss, MS 39474-0819

Phone

(601) 792-4959

Fax

(601) 792-4003

NPI assigned

Oct 13, 2006

Last updated

Oct 6, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Lee

Title

Owner

Phone

(601) 792-4959

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PALACE DRUG STORE Doing business as

Tax ID family

Gregory T Lee2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lee's Drug Store

  • Pharmacist
  • Newhebron, MS
  • NPI 1215140967
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1407946320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394740819",
            "telephone_number": "601-792-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2234 COLUMBIA AVE",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394740819",
            "telephone_number": "601-792-4959",
            "fax_number": "601-792-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY T LEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2016-10-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-792-4959"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "04377/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043400",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330448",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALACE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Forrest County General Hospital (Jefferson Davis Rural Health Clinic)
• Forrest County General Hospital (Jefferson Davis General Hospital)
• Keely Fortenberry
• Stephanie Gardner, CCSS
• Kimberly Gholar
• Renee V Harrien
• Hattiesburg Clinic PA (Prentiss Family Practice Clinic)
• Brittainey Monique Hooker
• Hudson Pharmacy, Inc. (Hudson Drugs)
• Gregory L Jackson, MSW

• Community/Retail Pharmacy in Prentiss, MS
• Providers in Prentiss, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.