Provider Demographics
NPI:1689161630
Name:KINGS HWY RX CORP
Entity Type:Organization
Organization Name:KINGS HWY RX CORP
Other - Org Name:KINGS RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:VLADISLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURSHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-975-0781
Mailing Address - Street 1:1214 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1010
Mailing Address - Country:US
Mailing Address - Phone:718-975-0781
Mailing Address - Fax:718-975-0782
Practice Address - Street 1:1214 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1010
Practice Address - Country:US
Practice Address - Phone:718-975-0781
Practice Address - Fax:718-975-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0365413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177271OtherPK