Healthcare Provider Details

I. General information

NPI: 1326477605
Provider Name (Legal Business Name): KTJ ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 02/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 SOUTH COLORADO AVENUE
STUART FL
34994-3016
US

IV. Provider business mailing address

622 SOUTH COLORADO AVE
STUART FL
34994-3016
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-3443
  • Fax: 772-287-0087
Mailing address:
  • Phone: 772-287-3443
  • Fax: 772-287-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH27423
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM E BAMHART
Title or Position: PHARMACIST
Credential: PHARM D, R.PH
Phone: 561-870-9672