Provider Demographics
NPI:1790821312
Name:SKJ INC
Entity Type:Organization
Organization Name:SKJ INC
Other - Org Name:HOEY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-839-1634
Mailing Address - Street 1:217 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1105
Mailing Address - Country:US
Mailing Address - Phone:608-221-4639
Mailing Address - Fax:608-709-1270
Practice Address - Street 1:217 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1105
Practice Address - Country:US
Practice Address - Phone:608-221-4639
Practice Address - Fax:608-709-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WI9214-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2115453OtherPK
WI33210300Medicaid
1212000001Medicare NSC