Healthcare Provider Details

I. General information

NPI: 1710970504
Provider Name (Legal Business Name): KNIGHT PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4059 W DAVISON
DETROIT MI
48238-3262
US

IV. Provider business mailing address

2520 INDUSTRIAL ROW DR
TROY MI
48084-7035
US

V. Phone/Fax

Practice location:
  • Phone: 313-933-6740
  • Fax: 313-933-6741
Mailing address:
  • Phone: 248-540-8066
  • Fax: 248-540-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301004774
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN DEJONGH
Title or Position: PRESIDENT OF OPERATIONS
Credential:
Phone: 248-540-8066