Provider Demographics
NPI:1275772915
Name:JK SERVICES OF SARASOTA LLC
Entity Type:Organization
Organization Name:JK SERVICES OF SARASOTA LLC
Other - Org Name:LAKEWOOD RANCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PIREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-356-0955
Mailing Address - Street 1:6310 HEALTH PARK WAY
Mailing Address - Street 2:STE 130
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-907-1500
Mailing Address - Fax:941-907-1544
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:STE 130
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-1500
Practice Address - Fax:941-907-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH238823336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119089OtherPK