Provider Demographics
NPI:1467817734
Name:KING KULLEN PHARMACIES CORP.
Entity Type:Organization
Organization Name:KING KULLEN PHARMACIES CORP.
Other - Org Name:KING KULLEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-733-7100
Mailing Address - Street 1:185 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3927
Mailing Address - Country:US
Mailing Address - Phone:516-733-7100
Mailing Address - Fax:516-827-6263
Practice Address - Street 1:440 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2254
Practice Address - Country:US
Practice Address - Phone:631-758-8292
Practice Address - Fax:631-758-0139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING KULLEN GROCERY CO. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy