Healthcare Provider Details

I. General information

NPI: 1003234758
Provider Name (Legal Business Name): KJK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 CHURCH ST
NASHVILLE TN
37203-2203
US

IV. Provider business mailing address

1913 CHURCH ST
NASHVILLE TN
37203-2203
US

V. Phone/Fax

Practice location:
  • Phone: 615-610-2804
  • Fax: 615-610-2853
Mailing address:
  • Phone: 615-610-2804
  • Fax: 615-610-2853

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 Number5362
License Number StateTN

VIII. Authorized Official

Name: CHRISTOPHER KONECNY
Title or Position: CFO, OWNER, PHARMD
Credential:
Phone: 615-446-8043