NPIMap

Organization Active NPI

King Kullen Pharmacy

  • Community/Retail Pharmacy
  • Valley Stream, NY
National Provider Identifier
1538217591
Registry record updated Sep 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
025582 Issued in NY
Legal business name
KING KULLEN PHARMACY
Practice address
231 W Merrick Rd
Valley Stream, NY 11580-5514
Phone
(516) 593-1505
Fax
(516) 593-2294
NPI assigned
Jan 8, 2007
Last updated
Sep 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2007

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 025582 NY Primary

Addresses

Primary practice location

231 W Merrick Rd
Valley Stream, NY 11580-5514

Mailing address

King Kullen Grocry Co Inc
185 Central Ave Dept 1030
Bethpage, NY 11714-3929

Other identifiers 3

IdentifierTypeStateIssuer
2375097MedicaidNY
3329617OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3329617OtherOTHER ID NUMBER

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.

Locations

231 W Merrick Rd
Valley Stream, NY 11580
Phone (516) 593-1505

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": "1189555200000",
    "number": "1538217591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KING KULLEN GROCRY CO INC",
            "address_2": "185 CENTRAL AVE DEPT 1030",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 W MERRICK RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805514",
            "telephone_number": "516-593-1505",
            "fax_number": "516-593-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-09-12",
        "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": "025582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2375097",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3329617",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3329617",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; 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.