Provider Demographics
NPI:1043037765
Name:THE KING'S FAMILY PHARMACY
Entity type:Organization
Organization Name:THE KING'S FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLATUNDUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAWOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-701-6221
Mailing Address - Street 1:1615 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669-6619
Mailing Address - Country:US
Mailing Address - Phone:202-701-6221
Mailing Address - Fax:
Practice Address - Street 1:1583 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-4334
Practice Address - Country:US
Practice Address - Phone:202-701-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy