Provider Demographics
NPI:1235237132
Name:PARK & KING PHARMACY INC
Entity Type:Organization
Organization Name:PARK & KING PHARMACY INC
Other - Org Name:PARK AND KING PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSRRT
Authorized Official - Phone:904-389-6602
Mailing Address - Street 1:4163 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4425
Mailing Address - Country:US
Mailing Address - Phone:904-389-6602
Mailing Address - Fax:904-389-7062
Practice Address - Street 1:4163 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4425
Practice Address - Country:US
Practice Address - Phone:904-389-6602
Practice Address - Fax:904-389-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
FLPH93413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007375OtherPK
FL101775600Medicaid
0765820001Medicare NSC