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General NPI Number Information
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NPI Number | 1669144572
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Entity Type | Individual
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Provider Name | JACOB RYAN KING PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | BLDG 50 FARENHOLT AVENUE
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City | AGANA HEIGHTS
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State | GU
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Zip | 96910
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Country | US
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Telephone | 671-344-9340
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 455 BOX 208
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City | FPO
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State | AP
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Zip | 96540-0003
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Country | US
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Telephone | 671-344-9340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202219751
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License Number State | VA
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