NPIMap

Organization Active NPI

King Kullen Pharmacies Corp

Doing business as King Kullen Pharmacy

  • Community/Retail Pharmacy
  • Center Moriches, NY
National Provider Identifier
1336297399
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
018406 Issued in NY
Legal business name
KING KULLEN PHARMACIES CORP
Doing business as
King Kullen Pharmacy
King Kullen Pharmacy #15
Practice address
552 Montauk Hwy
Center Moriches, NY 11934-2207
Phone
(631) 878-9030
Fax
(631) 878-9031
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Authorized official

Name
Albert Hesse, RPHNPI 1104009141
Title
Pharmacy Coordinator
Phone
(516) 733-7100

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 018406 NY Primary

Addresses

Primary practice location

552 Montauk Hwy
Center Moriches, NY 11934-2207

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2062260OtherPK

Other names 2

  • KING KULLEN PHARMACY Doing business as
  • King Kullen Pharmacy #15 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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1524096000000",
    "number": "1336297399",
    "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": "11714",
            "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": "552 MONTAUK HWY",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342207",
            "telephone_number": "631-878-9030",
            "fax_number": "631-878-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2018-04-19",
        "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": "018406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2062260",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KING KULLEN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "King Kullen Pharmacy #15",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Center Moriches, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.