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Organization
PMCJK LLC
Active
Organization
PMCJK LLC
Active
Other names
Preventative Medical Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN M KOHLL (PRESIDENT)
(402) 306-6503
Entity
Organization
Contact information
Practice address
620 N 114TH ST, OMAHA, NE 68154-1571
(402) 408-0015
(402) 408-0020
Mailing address
16705 ONTARIO PLZ, OMAHA, NE 68130-2131
(402) 306-6503
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
12/31/2019
Last updated
12/31/2019
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