Provider Demographics
NPI:1881791549
Name:KINGS PHARMACY LLC
Entity type:Organization
Organization Name:KINGS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-482-1556
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-0304
Mailing Address - Country:US
Mailing Address - Phone:973-482-1556
Mailing Address - Fax:973-482-1594
Practice Address - Street 1:33 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1043
Practice Address - Country:US
Practice Address - Phone:973-482-1556
Practice Address - Fax:973-482-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005282003336C0003X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6867111Medicaid
NJ6867103Medicaid
NJ6867103Medicaid