Active NPI
KJK LLC
Doing business as East Hickman Pharmacy
- Community/Retail Pharmacy
- Lyles, TN
National Provider Identifier
1184968455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1530
- Legal business name
- KJK LLC
- Doing business as
- East Hickman Pharmacy
- Practice address
- 7723 Clearview Church LN
Lyles, TN 37098-1674 - Phone
- (931) 670-6035
- Fax
- (931) 670-6399
- NPI assigned
- Nov 26, 2012
- Last updated
- Jan 17, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Christopher Konecny, PHARMD
- Title
- Cfo
- Phone
- (732) 580-5805
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1530 | TN | Primary |
Addresses
Primary practice location
7723 Clearview Church LN
Lyles, TN 37098-1674
Mailing address
7723 Clearview Church LN
Lyles, TN 37098-1674
Phone (931) 670-6035
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2138079 | Other | PK | |
| Q045581 | Medicaid | TN |
Other names 1
- East Hickman Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Church Street Pharmacy
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Dickson, TN
- NPI 1548709058
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353888000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1642377600000",
"number": "1184968455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7723 CLEARVIEW CHURCH LN",
"city": "LYLES",
"state": "TN",
"postal_code": "370981674",
"telephone_number": "931-670-6035",
"fax_number": "931-670-6399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7723 CLEARVIEW CHURCH LN",
"city": "LYLES",
"state": "TN",
"postal_code": "370981674",
"telephone_number": "931-670-6035",
"fax_number": "931-670-6399"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KJK LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-11-26",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A",
"authorized_official_last_name": "KONECNY",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "732-580-5805",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TN",
"license": "1530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2138079",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q045581",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "East Hickman Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "East Hickman Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lyles, TN
- Dickson Medical Associates, PC (DMA Lyles)
- Sarah Whitley Gagnon, LPC-MHSP
- Mark Allen Graves, FNP-BC
- Zilla F Henricksen, FNP-C
- Hickman Community Health Careservices (Hickman Medical Center)
- Brent Lee, D.D.S.
- Leah Gordon Lee, DDS
- Nicholas Paul Malinowski, DMD
- Bobby Gene Manor II, LPTA
- Stephen M McClellan, P.T.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.