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General NPI Number Information
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NPI Number | 1548767650
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Entity Type | Organization
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Legal Business Name | KING TUT PHARMACY LLC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 90 E 3RD ST SUITE B
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City | DOUGLAS
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State | AZ
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Zip | 85607-3154
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Country | US
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Telephone | 520-364-6304
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Fax | 520-634-1157
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Provider Business Mailing Address
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Address Line | 90 E 3RD ST SUITE B
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City | DOUGLAS
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State | AZ
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Zip | 85607-3154
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Country | US
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Telephone | 520-364-6304
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Fax | 520-634-1157
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Authorized Official
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Title or Position | OWNER/PIC/AO
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Name | KARIEM ISMAIL
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Credential |
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Telephone | 520-220-1281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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