# KJ 'S PHARMACY,INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KJ Pharmacy \#129
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720404122
- **Authorized official:** SPENCER PLAYER RPH (PHARMACIST IN CHARGE)
- **Authorized official phone:** (843) 374-1110

## Contact information

- **Practice address:** 240 KELLEY ST, LAKE CITY, SC 29560-2416
- **Practice address phone:** (843) 374-1110
- **Practice address fax:** (843) 374-1117
- **Mailing address:** 240 KELLEY ST, LAKE CITY, SC 29560-2416
- **Mailing address phone:** (843) 374-1110
- **Mailing address fax:** (843) 374-1117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 15075 | SC | Yes |

## Other

- **Enumeration date:** 03/10/2014
- **Last updated:** 04/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2144526 | PK | — |
| 05 | — | 715075 | — | SC |