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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