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General NPI Number Information
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NPI Number | 1437472024
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Entity Type | Organization
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Legal Business Name | CKW SQUARED LLC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 14585 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77035-6560
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Country | US
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Telephone | 713-721-4040
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Fax | 713-721-1717
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Provider Business Mailing Address
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Address Line | 14585 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77035-6560
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Country | US
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Telephone | 713-721-4040
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Fax | 713-721-1717
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Authorized Official
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Title or Position | OWNER
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Name | KELLIE POTTS
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Credential |
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Telephone | 713-721-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26821
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License Number State | TX
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