MEDICARE: C&K EXPRESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0002152	OR
2	333600000X	Pharmacy	0002152	OR
3	3336C0003X	Community/Retail Pharmacy	0002152	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	133504	OTHER		MEDICARE FLU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0002152	OTHER	OR	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3815214	OTHER	OR	NCPDP

General Provider Information

NPI Number	:	1356337323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&K EXPRESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 357
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-0357
Country	:	US
Telephone Number	:	530-918-9200
Fax Number	:	530-918-9100

Provider Business Practice Location Address
First Line	:	11148 HIGHWAY 62
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-9779
Country	:	US
Telephone Number	:	541-826-9380
Fax Number	:	541-826-9623

Authorized Official
Title or Position	:	PRESIDENT RPE, MEMBER
Name	:	CHRIS RICHMOND
Credential	:	RPH
Telephone Number	:	530-918-9200

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	09/11/2025

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Directions to “C&K EXPRESS, LLC ” Practice Location

Language	Start Address	Practice Location

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