Jlkgt Investments LLC
Organization Active NPI Community/Retail Pharmacy · Versailles, OH
NPI 1710069554 · NPPES record last updated Feb 20, 2017
Key facts
- NPI
- 1710069554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 022452100 (OH)
- Legal business name
- JLKGT INVESTMENTS LLC
- Practice address
- 42 W Main St
Versailles, OH 45380-1214 - Phone
- (937) 526-3337
- Fax
- (937) 526-4118
- NPI assigned
- Oct 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Jacquelyn Briscoe
- Title
- Owner
- Phone
- (937) 526-3337
Other NPIs on the same Medicare enrollment 2
Practitioners 4
-
Jacquelyn Lee Briscoe, PHARM D
-
Jared Briscoe, PHARMD
-
Dawn R Goodwin, RPH
-
Kevin E Subler, PD PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2098733 | Jlkgt Investments LLC Dba Kaup Pharmacy | Certificate of waiver | Jul 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Jlkgt Investments LLC |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Traction Equipment|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Ur… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090319000303 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 0941367908 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fort Recovery, OH; Union City, OH |
| O20150804003903 | OH | DME Supplier - Pharmacy | 4981918919 | Practice locations: Versailles, OH |
| O20151021000539 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 4981918919 | Practice locations: Versailles, OH |
National Provider Directory
Locations
42 W Main St
Versailles, OH 45380
Phone (937) 526-3337
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 022452100 | OH | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
42 W Main St
Versailles, OH 45380-1214
Mailing address
42 W Main St
Versailles, OH 45380-1214
Phone (937) 526-3337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0112030 | Medicaid | OH | |
| 2148087 | Other | PK |
Other names
- KAUP PHARMACY
Other providers in Versailles, OH
- Alec Heffner
- Andrea Heitkamp
- Christina Hess
- Danielle Marie Hesson
- Kristin Hopf
- Julia Anne Bowlin MD
- Erin L Keller
- Robert C Klamar
- Jon Anthony Kremer
- Courtney Lyons
All providers in Versailles, OH · Community/Retail Pharmacy in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.