| Organization Name: | KING GEORGE PHARMACY, INC. |
| NPI Number: | 1578532842 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM B. GALLAHAN (OWNER) |
| Mailing Address: | 11463 Ridge Rd King George |
| State: | VA US |
| Postal Code: | 224854078 |
| Phone Number: | 5407759200 |
| Fax Number: | 5407754011 |
| NPI Enumeration Date: | 03/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 0201001219 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |