1356499313 NPI number — KING KULLEN PHARMACIES CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356499313 NPI number — KING KULLEN PHARMACIES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KING KULLEN PHARMACIES CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356499313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
598 STEWART AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-1738
Provider Business Practice Location Address Fax Number:
516-822-3754
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HESSE
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY COORDINATOR
Authorized Official Telephone Number:
516-733-7100

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 026220 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3338868 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02577851 NY , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3338868 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com