Healthcare Provider Details

I. General information

NPI: 1851728703
Provider Name (Legal Business Name): KING PHARMACY & COMPOUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31201 US HIGHWAY 19 N
PALM HARBOR FL
34684-4422
US

IV. Provider business mailing address

31201 US HIGHWAY 19 N SUITE 1
PALM HARBOR FL
34684-4422
US

V. Phone/Fax

Practice location:
  • Phone: 727-772-6868
  • Fax: 727-772-6969
Mailing address:
  • Phone: 727-772-6868
  • Fax: 727-772-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28918
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHADY ABDELMASIH
Title or Position: RPH MANAGER
Credential:
Phone: 727-772-6868