Provider Demographics
NPI:1033120522
Name:CCK INC
Entity Type:Organization
Organization Name:CCK INC
Other - Org Name:ST GEORGE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-398-7416
Mailing Address - Street 1:237 N BLUFF ST
Mailing Address - Street 2:SUITES A AND B
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4543
Mailing Address - Country:US
Mailing Address - Phone:435-628-4554
Mailing Address - Fax:435-628-3592
Practice Address - Street 1:237 N BLUFF ST
Practice Address - Street 2:SUITES A AND B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4543
Practice Address - Country:US
Practice Address - Phone:435-628-4554
Practice Address - Fax:435-628-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
UT709487917033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4610538OtherNCPDP PROVIDER IDENTIFICATION NUMBER