Provider Demographics
NPI:1356337323
Name:C&K EXPRESS, LLC
Entity type:Organization
Organization Name:C&K EXPRESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT RPE, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-918-9200
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0357
Mailing Address - Country:US
Mailing Address - Phone:530-918-9200
Mailing Address - Fax:530-918-9100
Practice Address - Street 1:11148 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-9779
Practice Address - Country:US
Practice Address - Phone:541-826-9380
Practice Address - Fax:541-826-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0002152332B00000X, 3336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0002152OtherLICENSE
OR274974Medicaid
133504OtherMEDICARE FLU
OR3815214OtherNCPDP
OR3815214OtherNCPDP
4709200002Medicare NSC