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General NPI Number Information
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NPI Number | 1174671135
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Entity Type | Organization
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Legal Business Name | KING KULLEN PHARMACIES CORP
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 31525 MAIN RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-1343
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Country | US
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Telephone | 631-734-7733
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Fax | 631-734-2193
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Provider Business Mailing Address
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Address Line | KING KULLEN GROCERY CO INC 185 CENTRAL AVE DEPT 1030
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City | BETHPAGE
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State | NY
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Zip | 11714-3929
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Country | US
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Telephone | 516-733-7100
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Fax | 516-827-6263
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Authorized Official
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Title or Position | PHCY COORDINATOR
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Name | ALBERT HESSE
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Credential |
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Telephone | 516-733-7196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 018363
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License Number State | NY
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