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General NPI Number Information
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NPI Number | 1275973968
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Entity Type | Organization
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Legal Business Name | KINGSLEY PHARMACY
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 3663 W 6TH ST #102
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City | LOS ANGELES
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State | CA
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Zip | 90020-3049
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Country | US
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Telephone | 213-383-8877
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Fax | 213-368-1590
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Provider Business Mailing Address
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Address Line | 3663 W 6TH ST #102
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City | LOS ANGELES
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State | CA
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Zip | 90020-3049
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Country | US
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Telephone | 213-383-8877
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Fax | 213-368-1590
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MRS. JUNG SUN LEE
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Credential | PHARM.D.
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Telephone | 213-383-8877
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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 | 51431
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License Number State | CA
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