1508840976 NPI number — CMK, LLC

Table of content: (NPI 1508840976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508840976 NPI number — CMK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARKET DRUG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508840976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 SPRINGS RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28601-3169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-256-0084
Provider Business Mailing Address Fax Number:
828-256-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2515 SPRINGS RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-256-0084
Provider Business Practice Location Address Fax Number:
828-256-0093
Provider Enumeration Date:
11/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROW
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE/OWNER
Authorized Official Telephone Number:
828-256-0084

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  09163 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0186264 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3404706 . This is a "NABP OR NCPDP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".