=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679271233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K&J PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 02/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 LIVINGSTON ST STE 4
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-272-6224
-----------------------------------------------------
Fax | 201-272-6225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 LIVINGSTON ST STE 4
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-272-6224
-----------------------------------------------------
Fax | 201-272-6225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | DR. JISUP HAN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 857-203-1678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------