Provider Demographics
NPI:1659663714
Name:KJL CONSULTANTS INC
Entity Type:Organization
Organization Name:KJL CONSULTANTS INC
Other - Org Name:LUKE'S YREKA DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-842-2600
Mailing Address - Street 1:829 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3320
Mailing Address - Country:US
Mailing Address - Phone:530-842-2600
Mailing Address - Fax:530-842-5173
Practice Address - Street 1:829 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3320
Practice Address - Country:US
Practice Address - Phone:530-842-2600
Practice Address - Fax:530-842-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY507153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659663714Medicaid
2130276OtherPK