Provider Demographics
NPI:1053595967
Name:CK PHARMACY
Entity type:Organization
Organization Name:CK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:LAI-CHUN
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-326-7888
Mailing Address - Street 1:5990 AIRLINE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4233
Mailing Address - Country:US
Mailing Address - Phone:713-697-0610
Mailing Address - Fax:713-697-0708
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4233
Practice Address - Country:US
Practice Address - Phone:713-697-0610
Practice Address - Fax:713-697-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145868Medicaid