Provider Demographics
NPI:1467326439
Name:HIDALGO COMPOUNDING LLC, DBA KING PHARMACY
Entity type:Organization
Organization Name:HIDALGO COMPOUNDING LLC, DBA KING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-760-0292
Mailing Address - Street 1:1016 E 1500 RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-9267
Mailing Address - Country:US
Mailing Address - Phone:785-760-0292
Mailing Address - Fax:
Practice Address - Street 1:1112 W 6TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-843-4516
Practice Address - Fax:785-843-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy