Provider Demographics
NPI:1093019259
Name:KING LTC LLC
Entity Type:Organization
Organization Name:KING LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:409-832-6100
Mailing Address - Street 1:755 S 11TH STREET, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701
Mailing Address - Country:US
Mailing Address - Phone:409-832-6100
Mailing Address - Fax:409-832-0159
Practice Address - Street 1:755 S 11TH STREET, SUITE 101
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-832-6100
Practice Address - Fax:409-832-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272913336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27291TOtherPHARMACY LICENSE