Provider Demographics
NPI:1578194957
Name:KING, JADE-ANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JADE-ANNA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 WAYCROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NC
Mailing Address - Zip Code:28453
Mailing Address - Country:US
Mailing Address - Phone:919-805-5210
Mailing Address - Fax:
Practice Address - Street 1:134 LIBERTY SQ STE B
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8602
Practice Address - Country:US
Practice Address - Phone:910-296-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist