Healthcare Provider Details

I. General information

NPI: 1548450356
Provider Name (Legal Business Name): CMK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 SPRINGS RD NE
HICKORY NC
28601-3169
US

IV. Provider business mailing address

2515 SPRINGS RD NE
HICKORY NC
28601-3169
US

V. Phone/Fax

Practice location:
  • Phone: 828-256-0084
  • Fax: 828-256-0093
Mailing address:
  • Phone: 828-256-0084
  • Fax: 828-256-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7704492
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09163
License Number StateNC

VIII. Authorized Official

Name: DR. JEFFREY BRIAN MERCER
Title or Position: OWNER-SEC/TREAS.
Credential: PHARM. D.
Phone: 828-256-0084