Provider Demographics
NPI:1033221957
Name:KP PHARMACY PLLC
Entity Type:Organization
Organization Name:KP PHARMACY PLLC
Other - Org Name:KING PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-721-5009
Mailing Address - Street 1:7101 ML KING JR WAY S
Mailing Address - Street 2:STE 101B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3594
Mailing Address - Country:US
Mailing Address - Phone:206-721-5009
Mailing Address - Fax:206-721-3931
Practice Address - Street 1:7101 ML KING JR WAY S
Practice Address - Street 2:STE 101B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3594
Practice Address - Country:US
Practice Address - Phone:206-721-5009
Practice Address - Fax:206-721-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHARCF000054653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110343OtherPK
WA6018948Medicaid