Provider Demographics
NPI:1184744492
Name:KING, BRIAN JAMES (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8032
Mailing Address - Country:US
Mailing Address - Phone:724-627-7348
Mailing Address - Fax:
Practice Address - Street 1:66 W PIKE ST
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1314
Practice Address - Country:US
Practice Address - Phone:724-745-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032129L1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support