Healthcare Provider Details

I. General information

NPI: 1356337323
Provider Name (Legal Business Name): C&K EXPRESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11148 HIGHWAY 62
EAGLE POINT OR
97524-9779
US

IV. Provider business mailing address

PO BOX 357
MOUNT SHASTA CA
96067-0357
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-9380
  • Fax: 541-826-9623
Mailing address:
  • Phone: 530-918-9200
  • Fax: 530-918-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0002152
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0002152
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0002152
License Number StateOR

VIII. Authorized Official

Name: CHRIS RICHMOND
Title or Position: PRESIDENT RPE, MEMBER
Credential: RPH
Phone: 530-918-9200