Provider Demographics
NPI:1740349216
Name:CK KC INC
Entity type:Organization
Organization Name:CK KC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-838-1300
Mailing Address - Street 1:22 EAST MAIN STREET
Mailing Address - Street 2:PALMYRA PHARMACY & GIFT SHOP
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078
Mailing Address - Country:US
Mailing Address - Phone:717-838-1300
Mailing Address - Fax:717-838-7234
Practice Address - Street 1:22 EAST MAIN STREET
Practice Address - Street 2:PALMYRA PHARMACY & GIFT SHOP
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078
Practice Address - Country:US
Practice Address - Phone:717-838-1300
Practice Address - Fax:717-838-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411871L3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007293870007Medicaid
PA1007293870007Medicaid