Provider Demographics
NPI:1083036016
Name:C AND K PHARMACY
Entity Type:Organization
Organization Name:C AND K PHARMACY
Other - Org Name:QUICK CARE PHARMACY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-307-2221
Mailing Address - Street 1:350 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4613
Mailing Address - Country:US
Mailing Address - Phone:662-307-2221
Mailing Address - Fax:662-307-2438
Practice Address - Street 1:350 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4613
Practice Address - Country:US
Practice Address - Phone:662-307-2221
Practice Address - Fax:662-307-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12961/1.13336C0003X, 3336C0003X
333600000X, 3336C0002X, 3336L0003X, 3336M0003X, 3336S0011X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143618OtherPK
MS08188783Medicaid
MS08188783Medicaid
MS392310Medicare UPIN