Basic Information
| Provider Information | |||||||||
| NPI: | 1073113643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3819 LAROUX AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232371978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176905708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9714 SLIDING HILL RD | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230057940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045373005 | ||||||||
| FaxNumber: | 8045373004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2020 | ||||||||
| LastUpdateDate: | 10/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202208150 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.