Organization
KING'S PHARMACY AND COMPOUNDING CENTER
Active
Organization
KING'S PHARMACY AND COMPOUNDING CENTER
Active
Other names
King's Pharmacy and Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALI REZAEI (PIC/OWNER)
(949) 244-9415
Entity
Organization
Contact information
Practice address
510 SUPERIOR AVE STE 120, NEWPORT BEACH, CA 92663-3665
(949) 631-4624
(949) 631-4626
Mailing address
510 SUPERIOR AVE, SUITE 120, NEWPORT BEACH, CA 92663-3663
(949) 631-4624
(949) 631-4626
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY50750
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132199
PK
—
Enumeration date
10/06/2011
Last updated
05/09/2014
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