MEDICARE: KING'S PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1811510712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING'S PHARMACY

Provider Business Mailing Address
First Line	:	7043 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7043 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9132
Country	:	US
Telephone Number	:	513-804-3266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TATUM KING
Credential	:
Telephone Number	:	513-804-3266

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	05/26/2020

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Directions to “KING'S PHARMACY ” Practice Location

Language	Start Address	Practice Location

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