Provider Demographics
NPI:1841343399
Name:KING PHARMACY, INC
Entity type:Organization
Organization Name:KING PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:606-435-1067
Mailing Address - Street 1:900 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9476
Mailing Address - Country:US
Mailing Address - Phone:606-435-1067
Mailing Address - Fax:606-435-1073
Practice Address - Street 1:900 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9476
Practice Address - Country:US
Practice Address - Phone:606-435-1067
Practice Address - Fax:606-435-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90012816332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012816Medicaid
KY90012816Medicaid