Provider Demographics
NPI:1417731571
Name:KING, MARY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1602
Mailing Address - Country:US
Mailing Address - Phone:716-385-8241
Mailing Address - Fax:
Practice Address - Street 1:4919 ELLICOTT RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3357
Practice Address - Country:US
Practice Address - Phone:716-503-1176
Practice Address - Fax:716-503-1175
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist