Provider Demographics
NPI:1831700855
Name:KINGSLEY RX LLC
Entity type:Organization
Organization Name:KINGSLEY RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFALCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:904-409-1337
Mailing Address - Street 1:1542 KINGSLEY AVE STE 142
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4547
Mailing Address - Country:US
Mailing Address - Phone:904-409-1337
Mailing Address - Fax:904-375-1362
Practice Address - Street 1:1542 KINGSLEY AVE STE 142
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4547
Practice Address - Country:US
Practice Address - Phone:904-409-1337
Practice Address - Fax:904-375-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy