Provider Demographics
NPI:1629189899
Name:KING DRUG CO., LLC
Entity Type:Organization
Organization Name:KING DRUG CO., LLC
Other - Org Name:KING DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD/PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-983-3147
Mailing Address - Street 1:P.O. BOX 426
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021
Mailing Address - Country:US
Mailing Address - Phone:336-983-3147
Mailing Address - Fax:336-985-0615
Practice Address - Street 1:142 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-3147
Practice Address - Fax:336-985-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01706183500000X
NC03816183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3407966OtherNABP
NC085531Medicaid
NC0855031Medicaid
NC0855031OtherMEDICARE
3407966OtherNABP