Provider Demographics
NPI:1023393808
Name:KING, HOWARD
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1201
Mailing Address - Country:US
Mailing Address - Phone:610-245-2155
Mailing Address - Fax:844-580-3695
Practice Address - Street 1:4930 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1201
Practice Address - Country:US
Practice Address - Phone:610-245-2155
Practice Address - Fax:844-580-3695
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004193183500000X
NJ28RJ03566183500000X
PARPI005438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist