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NPI Code Detail

MEDICARE: DR. ELLEN KING PHARM.D., MBA, FACHE

MEDICARE: DR. ELLEN KING PHARM.D., MBA, FACHE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist22549FL
2183500000XPharmacist014806GA

General Provider Information

NPI Number : 1184623399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN KING PHARM.D., MBA, FACHE
Provider Business Mailing Address
First Line : 145 STEAM MILL RD
Second Line :
City : BRINSON
State : GA
Zip : 39825-2127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 417 W 3RD AVE
Second Line :
City : ALBANY
State : GA
Zip : 31701-1943
Country : US
Telephone Number : 229-312-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/06/2021

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