Provider Demographics
NPI:1578877940
Name:KING PHARMACY INC
Entity Type:Organization
Organization Name:KING PHARMACY INC
Other - Org Name:KING PHARMACY, SOMERSET
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:606-435-1067
Mailing Address - Street 1:900 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9476
Mailing Address - Country:US
Mailing Address - Phone:606-435-1067
Mailing Address - Fax:606-435-1073
Practice Address - Street 1:311 BOGLE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-451-2112
Practice Address - Fax:606-451-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07408333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5564170002Medicare NSC