Provider Demographics
NPI:1275973968
Name:KINGSLEY PHARMACY
Entity Type:Organization
Organization Name:KINGSLEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNG SUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:213-383-8877
Mailing Address - Street 1:3663 W 6TH ST
Mailing Address - Street 2:#102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3049
Mailing Address - Country:US
Mailing Address - Phone:213-383-8877
Mailing Address - Fax:213-368-1590
Practice Address - Street 1:3663 W 6TH ST
Practice Address - Street 2:#102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3049
Practice Address - Country:US
Practice Address - Phone:213-383-8877
Practice Address - Fax:213-368-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy