Provider Demographics
NPI:1093000440
Name:KING, STEPHEN BISHARE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BISHARE
Last Name:KING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2204
Mailing Address - Country:US
Mailing Address - Phone:509-853-6878
Mailing Address - Fax:
Practice Address - Street 1:711 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1153
Practice Address - Country:US
Practice Address - Phone:509-865-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60170167183500000X
OKR-14853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist