Provider Demographics
NPI:1104128693
Name:KING KULLEN PHARMACIES CORP
Entity type:Organization
Organization Name:KING KULLEN PHARMACIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-733-7196
Mailing Address - Street 1:185 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3927
Mailing Address - Country:US
Mailing Address - Phone:516-733-7100
Mailing Address - Fax:516-827-6263
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3927
Practice Address - Country:US
Practice Address - Phone:516-733-7100
Practice Address - Fax:516-827-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING KULLEN GROCERY CO. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018363333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy