Provider Demographics
NPI:1467708586
Name:KJK LLC
Entity Type:Organization
Organization Name:KJK LLC
Other - Org Name:GOODLARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD, CFO
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:732-580-5805
Mailing Address - Street 1:127 CRESTVIEW PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2854
Mailing Address - Country:US
Mailing Address - Phone:615-446-8043
Mailing Address - Fax:615-446-7556
Practice Address - Street 1:127 CRESTVIEW PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2854
Practice Address - Country:US
Practice Address - Phone:615-446-8043
Practice Address - Fax:615-446-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000003243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136605OtherPK