Healthcare Provider Details

I. General information

NPI: 1245602598
Provider Name (Legal Business Name): RKJ HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508-2 W. US 60
MOUNTAIN VIEW MO
65548
US

IV. Provider business mailing address

10370 PR 8827
WEST PLAINS MO
65775
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-7706
  • Fax:
Mailing address:
  • Phone: 417-255-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2015038140
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONALD JENSEN
Title or Position: SOLE OWNER
Credential:
Phone: 417-255-6713