Healthcare Provider Details

I. General information

NPI: 1356782957
Provider Name (Legal Business Name): MICHAEL KING PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 E CAROL AVE
MESA AZ
85206-1338
US

IV. Provider business mailing address

5323 E CAROL AVE
MESA AZ
85206-1338
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-7340
  • Fax:
Mailing address:
  • Phone: 845-217-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number055751
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS021886
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021886
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: