King Kullen Pharmacies Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

028811 Issued in NY

Legal business name

KING KULLEN PHARMACIES CORP

Doing business as

King Kullen Pharmacy

Practice address

4343 Amboy Rd
Staten Island, NY 10312

Phone

(718) 984-6073

Fax

(718) 984-3607

NPI assigned

Apr 11, 2008

Last updated

May 4, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. J Donald Kennedy

Title

Treasurer Director

Phone

(516) 733-7147

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• KING KULLEN PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272931200000",
    "number": "1922271790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 CENTRAL AVE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "11714",
            "telephone_number": "516-733-7196",
            "fax_number": "516-827-6263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 AMBOY RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10312",
            "telephone_number": "718-984-6073",
            "fax_number": "718-984-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING KULLEN PHARMACIES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2010-05-04",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "TREASURER DIRECTOR",
        "authorized_official_telephone_number": "516-733-7147",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "028811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02965328",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3357680",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3357680",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KING KULLEN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; 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.