Provider Demographics
NPI:1437472024
Name:CKW SQUARED LLC
Entity Type:Organization
Organization Name:CKW SQUARED LLC
Other - Org Name:MAIN STOP RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-721-4040
Mailing Address - Street 1:14585 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6560
Mailing Address - Country:US
Mailing Address - Phone:713-721-4040
Mailing Address - Fax:713-721-1717
Practice Address - Street 1:14585 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6560
Practice Address - Country:US
Practice Address - Phone:713-721-4040
Practice Address - Fax:713-721-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4555251OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX6490590001Medicare NSC