Provider Demographics
NPI:1477842029
Name:CDK LLC
Entity Type:Organization
Organization Name:CDK LLC
Other - Org Name:MCEWEN PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-202-2310
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-0286
Mailing Address - Country:US
Mailing Address - Phone:931-582-8808
Mailing Address - Fax:931-582-7707
Practice Address - Street 1:10033 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4490
Practice Address - Country:US
Practice Address - Phone:931-582-8808
Practice Address - Fax:931-582-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN48613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129995OtherPK
TN6715000001Medicare NSC