Healthcare Provider Details

I. General information

NPI: 1467708586
Provider Name (Legal Business Name): KJK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CRESTVIEW PARK DR STE 100
DICKSON TN
37055-2854
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 100
DICKSON TN
37055-2854
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-8043
  • Fax: 615-446-7556
Mailing address:
  • Phone: 615-446-8043
  • Fax: 615-446-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000000324
License Number StateTN

VIII. Authorized Official

Name: CHRISTOPHER KONECNY
Title or Position: PHARMD, CFO
Credential:
Phone: 732-580-5805