NPIMap

Organization Active NPI

King Kullen Pharmacies Corp

  • Community/Retail Pharmacy
  • Manorville, NY
National Provider Identifier
1710035779
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
025333 Issued in NY
Legal business name
KING KULLEN PHARMACIES CORP
Practice address
460 County Road 111
Manorville, NY 11949-3372
Phone
(631) 399-0346
Fax
(631) 399-1436
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
KING KULLEN GROCOERY 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 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 025333 NY Primary

Addresses

Primary practice location

460 County Road 111
Manorville, NY 11949-3372

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
3325291OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3325291OtherOTHER ID NUMBER
2280784MedicaidNY

Other names 1

  • King Kullen Pharmacy #33 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

460 County Road 111
Manorville, NY 11949
Phone (631) 399-0346

Practitioners & affiliated clinicians

Practitioners 2

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": "1512691200000",
    "number": "1710035779",
    "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": "460 COUNTY ROAD 111",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119493372",
            "telephone_number": "631-399-0346",
            "fax_number": "631-399-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING KULLEN GROCOERY 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": "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": "025333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3325291",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3325291",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2280784",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Kullen Pharmacy #33",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manorville, 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.