Provider Demographics
NPI:1700824885
Name:FORD DRUG INC
Entity Type:Organization
Organization Name:FORD DRUG INC
Other - Org Name:KINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-738-9494
Mailing Address - Street 1:7410 W BOYNTON BEACH BLVD
Mailing Address - Street 2:STE A4
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6156
Mailing Address - Country:US
Mailing Address - Phone:561-738-9494
Mailing Address - Fax:561-738-7470
Practice Address - Street 1:7410 W BOYNTON BEACH BLVD
Practice Address - Street 2:STE A4
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6156
Practice Address - Country:US
Practice Address - Phone:561-738-9494
Practice Address - Fax:561-738-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH188473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015158OtherPK
5465490001Medicare NSC