Provider Demographics
NPI:1184968455
Name:KJK LLC
Entity type:Organization
Organization Name:KJK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-580-5805
Mailing Address - Street 1:7723 CLEARVIEW CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-1674
Mailing Address - Country:US
Mailing Address - Phone:931-670-6035
Mailing Address - Fax:931-670-6399
Practice Address - Street 1:7723 CLEARVIEW CHURCH LN
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-1674
Practice Address - Country:US
Practice Address - Phone:931-670-6035
Practice Address - Fax:931-670-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN15303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138079OtherPK
TNQ045581Medicaid