Provider Demographics
NPI:1073113643
Name:KING, JOHN R JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:KING
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 LAROUX AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1978
Mailing Address - Country:US
Mailing Address - Phone:817-690-5708
Mailing Address - Fax:
Practice Address - Street 1:9714 SLIDING HILL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7940
Practice Address - Country:US
Practice Address - Phone:804-537-3005
Practice Address - Fax:804-537-3004
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist