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General NPI Number Information
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NPI Number | 1184968455
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Entity Type | Organization
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Legal Business Name | KJK LLC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 7723 CLEARVIEW CHURCH LN
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City | LYLES
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State | TN
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Zip | 37098-1674
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Country | US
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Telephone | 931-670-6035
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Fax | 931-670-6399
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Provider Business Mailing Address
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Address Line | 7723 CLEARVIEW CHURCH LN
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City | LYLES
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State | TN
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Zip | 37098-1674
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Country | US
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Telephone | 931-670-6035
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Fax | 931-670-6399
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Authorized Official
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Title or Position | CFO
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Name | CHRISTOPHER KONECNY
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Credential | PHARMD
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Telephone | 732-580-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1530
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License Number State | TN
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