Provider Demographics
NPI:1003234758
Name:KJK LLC
Entity Type:Organization
Organization Name:KJK LLC
Other - Org Name:CHURCH STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, OWNER, PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-446-8043
Mailing Address - Street 1:1913 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2203
Mailing Address - Country:US
Mailing Address - Phone:615-610-2804
Mailing Address - Fax:615-610-2853
Practice Address - Street 1:1913 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2203
Practice Address - Country:US
Practice Address - Phone:615-610-2804
Practice Address - Fax:615-610-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN53623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145202OtherPK