Provider Demographics
NPI:1730680414
Name:KJK LLC
Entity Type:Organization
Organization Name:KJK LLC
Other - Org Name:GOODLARK PHARMACY AT FAIRVIEW
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:PAUL
Authorized Official - Last Name:KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-580-5805
Mailing Address - Street 1:2340 FAIRVIEW BLVD. SUITE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062
Mailing Address - Country:US
Mailing Address - Phone:615-387-9000
Mailing Address - Fax:615-266-2362
Practice Address - Street 1:2340 FAIRVIEW BLVD. SUITE 300
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062
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:2018-02-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy