Healthcare Provider Details

I. General information

NPI: 1245415801
Provider Name (Legal Business Name): KNIGHT AIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CENTRAL FLORIDA BLVD BLDG 137 STE K
ORLANDO FL
32816-8005
US

IV. Provider business mailing address

4000 CENTRAL FLORIDA BLVD BLDG 137 STE K
ORLANDO FL
32816-8005
US

V. Phone/Fax

Practice location:
  • Phone: 407-882-0600
  • Fax: 407-882-0603
Mailing address:
  • Phone: 407-882-0600
  • Fax: 407-882-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH23039
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHERYL GAMBLE
Title or Position: PHCY DIRECTOR
Credential: RPH
Phone: 407-823-6084