Provider Demographics
NPI:1255475505
Name:KING, SHAKEENA L (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:SHAKEENA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 STERLING DR
Mailing Address - Street 2:APT 1
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-1892
Mailing Address - Country:US
Mailing Address - Phone:812-484-6066
Mailing Address - Fax:
Practice Address - Street 1:4635 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3625
Practice Address - Country:US
Practice Address - Phone:812-463-0511
Practice Address - Fax:812-463-0516
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99022319A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician