Healthcare Provider Details

I. General information

NPI: 1982740544
Provider Name (Legal Business Name): SKJ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MAIN ST
DEERFIELD WI
53531-9353
US

IV. Provider business mailing address

431 W COTTAGE GROVE RD
COTTAGE GROVE WI
53527-9385
US

V. Phone/Fax

Practice location:
  • Phone: 608-764-8111
  • Fax: 608-764-5556
Mailing address:
  • Phone: 608-839-3784
  • Fax: 608-839-3786

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 Number838342
License Number StateWI

VIII. Authorized Official

Name: KEVIN HOEY
Title or Position: OWNER
Credential:
Phone: 608-839-3784