Organization
KGJ ENTERPRISES
Active
Other names
Simfarose Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE KELLY (MANAGER)
(561) 353-1292
Entity
Organization
Contact information
Practice address
6338 LANTANA RD, SUITE 52/53, LAKE WORTH, FL 33467
(561) 353-1292
(561) 353-1293
Mailing address
6338 LANTANA RD, SUITE 52/53, LAKE WORTH, FL 33467
(561) 353-1292
(561) 353-1293
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24364
FL
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5528075
—
FL
Enumeration date
12/14/2009
Last updated
02/13/2019
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