Provider Demographics
NPI:1891025789
Name:KING, NINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 115TH AVE NE APT 336
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7942
Mailing Address - Country:US
Mailing Address - Phone:505-270-4815
Mailing Address - Fax:
Practice Address - Street 1:25605 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7609
Practice Address - Country:US
Practice Address - Phone:253-813-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60095961183500000X
NMNM00006691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist