MEDICARE: SKJ INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	838342	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5127813	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982740544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKJ INC.

Provider Business Mailing Address
First Line	:	431 W COTTAGE GROVE RD
Second Line	:
City	:	COTTAGE GROVE
State	:	WI
Zip	:	53527-9385
Country	:	US
Telephone Number	:	608-839-3784
Fax Number	:	608-839-3786

Provider Business Practice Location Address
First Line	:	50 N MAIN ST
Second Line	:
City	:	DEERFIELD
State	:	WI
Zip	:	53531-9353
Country	:	US
Telephone Number	:	608-764-8111
Fax Number	:	608-764-5556

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN HOEY
Credential	:
Telephone Number	:	608-839-3784

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	09/22/2011

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