MEDICARE: CDK 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	4861	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2129995	OTHER		PK

General Provider Information

NPI Number	:	1477842029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDK LLC

Provider Business Mailing Address
First Line	:	PO BOX 286
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-0286
Country	:	US
Telephone Number	:	931-582-8808
Fax Number	:	931-582-7707

Provider Business Practice Location Address
First Line	:	10033 US HIGHWAY 70 E
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4490
Country	:	US
Telephone Number	:	931-582-8808
Fax Number	:	931-582-7707

Authorized Official
Title or Position	:	PHARMACIST
Name	:	RACHEL DONEGAN
Credential	:
Telephone Number	:	615-202-2310

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/25/2017

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Directions to “CDK LLC ” Practice Location

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