Provider Demographics
NPI:1467855346
Name:KP PHARMACY & MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:KP PHARMACY & MEDICAL SUPPLIES LLC
Other - Org Name:KING PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:206-721-5009
Mailing Address - Street 1:7101 MARTIN LUTHER KING JR WAY S STE 101B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3591
Mailing Address - Country:US
Mailing Address - Phone:206-721-5009
Mailing Address - Fax:206-721-3931
Practice Address - Street 1:7101 MARTIN LUTHER KING JR WAY S STE 101B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3591
Practice Address - Country:US
Practice Address - Phone:206-721-5009
Practice Address - Fax:206-721-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.60506847332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7315620001Medicare NSC