Provider Demographics
NPI:1083080162
Name:CKS HEALTHCARE /INC.
Entity Type:Organization
Organization Name:CKS HEALTHCARE /INC.
Other - Org Name:LAKESIDE PHARMACY SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-724-2090
Mailing Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4782
Mailing Address - Country:US
Mailing Address - Phone:956-724-2090
Mailing Address - Fax:956-724-2170
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY STE 208
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4782
Practice Address - Country:US
Practice Address - Phone:956-724-2090
Practice Address - Fax:956-724-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX308923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164466OtherPK
TX149502Medicaid