NPIMap

Organization Active NPI

King Kullen Pharmacy

  • Community/Retail Pharmacy
  • Bay Shore, NY
National Provider Identifier
1093863045
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
021231 Issued in NY
Legal business name
KING KULLEN PHARMACY
Practice address
440 E Main St
Bay Shore, NY 11706-8501
Phone
(631) 666-9090
Fax
(631) 665-9123
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
KING KULLEN GROCERY CO. INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Albert Hesse, RPH
Title
Pharmacy Coordinator
Phone
(516) 733-7100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 021231 NY Primary

Addresses

Primary practice location

440 E Main St
Bay Shore, NY 11706-8501

Mailing address

King Kullen Grocery Co Inc
185 Central Ave Dept 1030
Bethpage, NY 11714-3929
Phone (516) 733-7100

Other identifiers 3

IdentifierTypeStateIssuer
3321584OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3321584OtherOTHER ID NUMBER
01343553MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
King Kullen Pharmacies Corp12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1093863045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KING KULLEN GROCERY CO INC",
            "address_2": "185 CENTRAL AVE DEPT 1030",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143929",
            "telephone_number": "516-733-7100",
            "fax_number": "516-827-6263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068501",
            "telephone_number": "631-666-9090",
            "fax_number": "631-665-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING KULLEN GROCERY CO. INC.",
        "enumeration_date": "2007-01-08",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "516-733-7100",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "021231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3321584",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3321584",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01343553",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.