Provider Demographics
NPI:1700121019
Name:KING'S PHARMACY OF LUMBERTON
Entity Type:Organization
Organization Name:KING'S PHARMACY OF LUMBERTON
Other - Org Name:KING'S PHARMACY OF LUMBERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PLUNK
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:409-767-2955
Mailing Address - Street 1:1948 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2762
Mailing Address - Country:US
Mailing Address - Phone:409-983-3384
Mailing Address - Fax:
Practice Address - Street 1:139 NORTH LHS DR.
Practice Address - Street 2:SUITE 211
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657
Practice Address - Country:US
Practice Address - Phone:409-767-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy