Provider Demographics
NPI:1962516930
Name:RKJ RX INC
Entity type:Organization
Organization Name:RKJ RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-256-7706
Mailing Address - Street 1:1453 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1870
Mailing Address - Country:US
Mailing Address - Phone:417-256-7706
Mailing Address - Fax:417-257-2512
Practice Address - Street 1:1453 GIBSON ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1870
Practice Address - Country:US
Practice Address - Phone:417-256-7706
Practice Address - Fax:417-257-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090182163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601716103Medicaid
2619370OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2619370OtherNCPDP PROVIDER IDENTIFICATION NUMBER