MEDICARE: KING KULLEN PHARMACIES CORP

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	021969	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3341207	OTHER	OTHER ID NUMBER
3	3341207	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1265580229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING KULLEN PHARMACIES CORP

Provider Business Mailing Address
First Line	:	KING KULLEN GROCERY CO INC
Second Line	:	185 CENTRAL AVE DEPT 1030
City	:	BETHPAGE
State	:	NY
Zip	:	11714-3929
Country	:	US
Telephone Number	:	516-733-7100
Fax Number	:	516-827-6263

Provider Business Practice Location Address
First Line	:	3284 HEMPSTEAD TPKE
Second Line	:
City	:	LEVITTOWN
State	:	NY
Zip	:	11756-1345
Country	:	US
Telephone Number	:	516-579-2111
Fax Number	:	516-735-5080

Authorized Official
Title or Position	:	PHARMACY COORDINATOR
Name	:	ALBERT HESSE
Credential	:	RPH
Telephone Number	:	516-733-7100

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/08/2017

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Directions to “KING KULLEN PHARMACIES CORP ” Practice Location

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