Provider Demographics
NPI:1194333955
Name:CK WELLNESS & PHARMACY LLC
Entity type:Organization
Organization Name:CK WELLNESS & PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:832-644-9712
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-0013
Mailing Address - Country:US
Mailing Address - Phone:832-644-9712
Mailing Address - Fax:832-376-7558
Practice Address - Street 1:1110 KINGWOOD DR # 108
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3001
Practice Address - Country:US
Practice Address - Phone:832-596-7466
Practice Address - Fax:832-376-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150322Medicaid