Provider Demographics
NPI:1619060043
Name:T C K R INC
Entity Type:Organization
Organization Name:T C K R INC
Other - Org Name:FOOD CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:276-783-5761
Mailing Address - Street 1:910 N MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4140
Mailing Address - Country:US
Mailing Address - Phone:276-783-5761
Mailing Address - Fax:276-783-7676
Practice Address - Street 1:910 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4140
Practice Address - Country:US
Practice Address - Phone:276-783-5761
Practice Address - Fax:276-783-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010030043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8514798Medicaid
2104062OtherPK