Provider Demographics
NPI:1578532842
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:PHARMD
Authorized Official - Phone:540-775-9200
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-0122
Mailing Address - Country:US
Mailing Address - Phone:540-775-9200
Mailing Address - Fax:540-775-4011
Practice Address - Street 1:11463 RIDGE RD
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-4078
Practice Address - Country:US
Practice Address - Phone:540-775-9200
Practice Address - Fax:540-775-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001219261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0801230001Medicare ID - Type Unspecified