Provider Demographics
NPI:1285924431
Name:T&J ENTERPRISE LLC
Entity type:Organization
Organization Name:T&J ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-253-4384
Mailing Address - Street 1:1630 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2142
Mailing Address - Country:US
Mailing Address - Phone:316-775-3714
Mailing Address - Fax:316-775-3469
Practice Address - Street 1:1630 OHIO ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2142
Practice Address - Country:US
Practice Address - Phone:316-262-2001
Practice Address - Fax:316-775-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-103343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200717780BMedicaid
2129880OtherPK
KS200717780AMedicaid
KS200717780BMedicaid