Provider Demographics
NPI:1689987802
Name:KINGSLEY, MICHAEL S (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14025 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1918
Mailing Address - Country:US
Mailing Address - Phone:210-656-5041
Mailing Address - Fax:210-656-0239
Practice Address - Street 1:14025 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1918
Practice Address - Country:US
Practice Address - Phone:210-656-5041
Practice Address - Fax:210-656-0239
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist