Provider Demographics
NPI:1821691148
Name:KING, DAVID WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:KING
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 1:3926 MARGARET LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7850
Mailing Address - Country:US
Mailing Address - Phone:325-944-7319
Mailing Address - Fax:
Practice Address - Street 1:610 W 29TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-2828
Practice Address - Country:US
Practice Address - Phone:325-653-7088
Practice Address - Fax:325-655-4260
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist