Provider Demographics
NPI:1447330675
Name:LJB INC
Entity type:Organization
Organization Name:LJB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-765-3335
Mailing Address - Street 1:2415 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7941
Mailing Address - Country:US
Mailing Address - Phone:270-765-2157
Mailing Address - Fax:270-765-2357
Practice Address - Street 1:2415 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-2157
Practice Address - Fax:270-765-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801934OtherNCPDP
KYP08023OtherPHARMACY LICENSE
KY54002373Medicaid
KY9013047700OtherKYDME
KY54002373Medicaid
KY9013047700OtherKYDME