Provider Demographics
NPI:1043374937
Name:PHARMACY CENTER INC DBA KINGS PHARMACY
Entity Type:Organization
Organization Name:PHARMACY CENTER INC DBA KINGS PHARMACY
Other - Org Name:KINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:DOV
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:732-364-7302
Mailing Address - Street 1:251 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3343
Mailing Address - Country:US
Mailing Address - Phone:732-364-7302
Mailing Address - Fax:732-363-7721
Practice Address - Street 1:251 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3343
Practice Address - Country:US
Practice Address - Phone:732-364-7302
Practice Address - Fax:732-363-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS5170333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1032060001Medicare NSC