Provider Demographics
NPI:1760862502
Name:CK PHARMACIES LLC
Entity Type:Organization
Organization Name:CK PHARMACIES LLC
Other - Org Name:CK PHARMACY - MOUNDRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING-MEMBER OF CK PHARMACIES, L
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KUDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-345-8650
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-0112
Mailing Address - Country:US
Mailing Address - Phone:620-345-8650
Mailing Address - Fax:620-345-6312
Practice Address - Street 1:200 E PACK ST
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-8854
Practice Address - Country:US
Practice Address - Phone:620-345-8650
Practice Address - Fax:620-345-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-07
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
KS2-131833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153749OtherPK
KS201115700AMedicaid
2153749OtherPK