Provider Demographics
NPI:1689043002
Name:CKY PHARMACY INC
Entity Type:Organization
Organization Name:CKY PHARMACY INC
Other - Org Name:OTAY LAKES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CECILE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCARAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-583-0318
Mailing Address - Street 1:945 OTAY LAKES RD STE J
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3055
Mailing Address - Country:US
Mailing Address - Phone:619-326-9034
Mailing Address - Fax:619-326-9045
Practice Address - Street 1:945 OTAY LAKES RD STE J
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3055
Practice Address - Country:US
Practice Address - Phone:619-326-9034
Practice Address - Fax:619-326-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA534793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154175OtherPK