Pmcjk LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

PMCJK LLC

Doing business as

Preventative Medical Clinic Pharmacy

Practice address

620 N 114TH St
Omaha, NE 68154-1571

Phone

(402) 408-0015

Fax

(402) 408-0020

NPI assigned

Dec 31, 2019

Organization subpart

No

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

Authorized official

Name

Justin M Kohll

Title

President

Phone

(402) 306-6503

Specialties & licenses 1

Addresses

Other names 1

• Preventative Medical Clinic Pharmacy Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1902445414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16705 ONTARIO PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302131",
            "telephone_number": "402-306-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N 114TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681541571",
            "telephone_number": "402-408-0015",
            "fax_number": "402-408-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMCJK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-31",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "KOHLL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-306-6503"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Omaha",
            "affiliation": "N",
            "endpointDescription": "pharmacy",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "620 N 114th St",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681541571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Preventative Medical Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Elise Plummer, LIMHP, LMSW
• Eliza Rochford Plummer, DO
• Kent C Plummer, D.C.
• Regina Marie Plummer, DO
• James Anthony Plunkett IV
• Dah PO
• Tar Bleh PO
• Wah PO
• Britney Dawn Poage
• David P Poage, MD

• Compounding Pharmacy in Omaha, NE
• Providers in Omaha, NE by specialty
• Compounding Pharmacy in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; 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.