Provider Demographics
NPI:1831116664
Name:KING PHARMACY LLC
Entity Type:Organization
Organization Name:KING PHARMACY LLC
Other - Org Name:KING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-328-6101
Mailing Address - Street 1:1200 S JACKSON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 S JACKSON ST
Practice Address - Street 2:STE 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2026
Practice Address - Country:US
Practice Address - Phone:206-328-6101
Practice Address - Fax:206-328-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000586813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6029425Medicaid
4931968OtherNCPDP PROVIDER IDENTIFICATION NUMBER