Healthcare Provider Details

I. General information

NPI: 1790821312
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: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 COTTAGE GROVE RD
MADISON WI
53716-1105
US

IV. Provider business mailing address

217 COTTAGE GROVE RD
MADISON WI
53716-1105
US

V. Phone/Fax

Practice location:
  • Phone: 608-221-4639
  • Fax: 608-709-1270
Mailing address:
  • Phone: 608-221-4639
  • Fax: 608-709-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9214-42
License Number StateWI

VIII. Authorized Official

Name: KEVIN HOEY
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 608-839-1634