Provider Demographics
NPI:1174658702
Name:KING PINSON PHARMACY
Entity Type:Organization
Organization Name:KING PINSON PHARMACY
Other - Org Name:KING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-298-2222
Mailing Address - Street 1:920 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:ABERNATHY
Mailing Address - State:TX
Mailing Address - Zip Code:79311-3437
Mailing Address - Country:US
Mailing Address - Phone:806-298-2222
Mailing Address - Fax:806-298-2653
Practice Address - Street 1:920 AVENUE D
Practice Address - Street 2:
Practice Address - City:ABERNATHY
Practice Address - State:TX
Practice Address - Zip Code:79311-3437
Practice Address - Country:US
Practice Address - Phone:806-298-2222
Practice Address - Fax:806-298-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX176503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093030OtherPK
TX144622Medicaid