NPIMap

Organization Active NPI

King Kullen Pharmacies Corp

Doing business as King Kullen Pharmacy #3

  • Community/Retail Pharmacy
  • Cutchogue, NY
National Provider Identifier
1174671135
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
018363 Issued in NY
Legal business name
KING KULLEN PHARMACIES CORP
Doing business as
King Kullen Pharmacy #3
Practice address
31525 Main Rd
Cutchogue, NY 11935-1343
Phone
(631) 734-7733
Fax
(631) 734-2193
NPI assigned
Jan 8, 2007
Last updated
Dec 8, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
KING KULLEN GROCERY CO. INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

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

Authorized official

Name
Albert HesseNPI 1104009141
Title
Phcy Coordinator
Phone
(516) 733-7196

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 018363 NY Primary

Addresses

Primary practice location

31525 Main Rd
Cutchogue, NY 11935-1343

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
00861885MedicaidNY
018363OtherNYNY STATE PHARMACY LICENSE NUMBER
3381249OtherNCPDP NUMBER

Other names 1

  • King Kullen Pharmacy #3 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210519001061 NY Part B Supplier - Mass Immunization (Roster Biller Only) 4981813888 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Patchougue, NY; Middle Island, NY; Manorville, NY; Levittown, NY; Cutchogue, NY; Center Moriches, NY; Bethpage, NY; Huntington, NY

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

185 Central Ave
#1030
Bethpage, NY 11714

31525 Main Rd
Cutchogue, NY 11935
Phone (631) 734-7733

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1512691200000",
    "number": "1174671135",
    "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": "31525 MAIN RD",
            "city": "CUTCHOGUE",
            "state": "NY",
            "postal_code": "119351343",
            "telephone_number": "631-734-7733",
            "fax_number": "631-734-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING KULLEN GROCERY CO. INC.",
        "enumeration_date": "2007-01-08",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PHCY COORDINATOR",
        "authorized_official_telephone_number": "516-733-7196"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "018363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00861885",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE PHARMACY LICENSE NUMBER",
            "identifier": "018363",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3381249",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Kullen Pharmacy #3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cutchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.