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General NPI Number Information
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NPI Number | 1477882959
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Entity Type | Organization
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Legal Business Name | KGJ ENTERPRISES
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 6338 LANTANA RD SUITE 52/53
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City | LAKE WORTH
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State | FL
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Zip | 33467
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Country | US
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Telephone | 561-353-1292
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Fax | 561-353-1293
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Provider Business Mailing Address
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Address Line | 6338 LANTANA RD SUITE 52/53
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City | LAKE WORTH
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State | FL
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Zip | 33467
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Country | US
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Telephone | 561-353-1292
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Fax | 561-353-1293
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Authorized Official
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Title or Position | MANAGER
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Name | NICOLE KELLY
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Credential |
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Telephone | 561-353-1292
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24364
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License Number State | FL
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