Provider Demographics
NPI:1497724488
Name:KING GEORGE PHARMACY, INC.
Entity Type:Organization
Organization Name:KING GEORGE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:GALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-663-2665
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448-1975
Mailing Address - Country:US
Mailing Address - Phone:540-663-2665
Mailing Address - Fax:540-663-4275
Practice Address - Street 1:15427 DAHLGREN RD
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5619
Practice Address - Country:US
Practice Address - Phone:540-663-2665
Practice Address - Fax:540-663-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002539261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0801230001Medicare ID - Type Unspecified