Provider Demographics
NPI:1548450356
Name:CMK, LLC
Entity type:Organization
Organization Name:CMK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-SEC/TREAS.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:828-256-0084
Mailing Address - Street 1:2515 SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3169
Mailing Address - Country:US
Mailing Address - Phone:828-256-0084
Mailing Address - Fax:828-256-0093
Practice Address - Street 1:2515 SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3169
Practice Address - Country:US
Practice Address - Phone:828-256-0084
Practice Address - Fax:828-256-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC091633336C0003X
NC7704492332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704492OtherMEDICAID DME