NPIMap

Organization Active NPI

King Kullen Pharmacies Corp

Doing business as King Kullen Pharmacy #1

  • Community/Retail Pharmacy
  • Patchogue, NY
National Provider Identifier
1861419483
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
034329 Issued in NY
Legal business name
KING KULLEN PHARMACIES CORP
Doing business as
King Kullen Pharmacy #1
Practice address
440 E Sunrise Hwy
Patchogue, NY 11772-2254
Phone
(631) 758-8292
Fax
(631) 758-0139
NPI assigned
Jul 17, 2006
Last updated
Dec 8, 2017By the provider in NPPES
Organization subpart
No

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
Director of Pharmacy
Phone
(516) 733-7196

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 034329 NY Primary

Addresses

Primary practice location

440 E Sunrise Hwy
Patchogue, NY 11772-2254

Mailing address

440 E Sunrise Hwy
Patchogue, NY 11772-2254
Phone (631) 758-8292

Other identifiers 2

IdentifierTypeStateIssuer
02407849MedicaidNY
2155991OtherPK

Other names 1

  • King Kullen Pharmacy #1 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
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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

440 E Sunrise Hwy
Patchogue, NY 11772
Phone (631) 758-8292

Practitioners & affiliated clinicians

Practitioners 1

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": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512691200000",
    "number": "1861419483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 E SUNRISE HWY",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722254",
            "telephone_number": "631-758-8292",
            "fax_number": "631-758-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E SUNRISE HWY",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722254",
            "telephone_number": "631-758-8292",
            "fax_number": "631-758-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "516-733-7196"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "034329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02407849",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155991",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Kullen Pharmacy #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Patchogue, 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.