=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598852733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGS HIGHWAY CHEMISTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 11/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3402 AVENUE N
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-258-5858
-----------------------------------------------------
Fax | 718-258-2600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3402 AVENUE N
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-258-5858
-----------------------------------------------------
Fax | 718-258-2600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ANDREW EPSTEIN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 718-258-5858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 018539
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------