Provider Demographics
NPI:1326477605
Name:KTJ ENTERPRISES, LLC
Entity type:Organization
Organization Name:KTJ ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAMHART
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RPH
Authorized Official - Phone:561-870-9672
Mailing Address - Street 1:622 SOUTH COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3016
Mailing Address - Country:US
Mailing Address - Phone:772-287-3443
Mailing Address - Fax:772-287-0087
Practice Address - Street 1:622 SOUTH COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3016
Practice Address - Country:US
Practice Address - Phone:772-287-3443
Practice Address - Fax:772-287-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 333600000X
FLPH274233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010508900Medicaid
2144038OtherPK