Provider Demographics
NPI:1336744036
Name:KING, DAVID IRFAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:IRFAN
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OPAL DR
Mailing Address - Street 2:APPARTMENT NUMBER # F202
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801
Mailing Address - Country:US
Mailing Address - Phone:510-327-9216
Mailing Address - Fax:
Practice Address - Street 1:2944 MOUNTAIN CITY HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4495
Practice Address - Country:US
Practice Address - Phone:775-778-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist