NPIMap

Organization Active NPI

KJ Pharmacy Inc

  • Community/Retail Pharmacy
  • Lake City, SC
National Provider Identifier
1184001356
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
15075 Issued in SC
Legal business name
KJ PHARMACY INC
Practice address
240 Kelley St
Lake City, SC 29560-2416
Phone
(843) 389-2731
NPI assigned
Apr 27, 2015
Last updated
Apr 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John H Symons III
Title
VP
Phone
(843) 389-2731

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 15075 SC
Community/Retail Pharmacy 3336C0003X 15075 SC Primary

Addresses

Primary practice location

240 Kelley St
Lake City, SC 29560-2416

Mailing address

PO Box 1629
Lake City, SC 29560-1629
Phone (843) 389-2731

Other identifiers 1

IdentifierTypeStateIssuer
715075MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
KJ Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1184001356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1629",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295601629",
            "telephone_number": "843-389-2731",
            "fax_number": "843-389-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 KELLEY ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602416",
            "telephone_number": "843-389-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KJ PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "SYMONS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "843-389-2731",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "15075",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SC",
            "license": "15075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "715075",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.