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General NPI Number Information
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NPI Number | 1780257527
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Entity Type | Individual
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Provider Name | BREANNE MARIE KNIGHTLY RPH
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Gender | Female
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 17113 HARLEM AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-3369
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Country | US
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Telephone | 708-532-7477
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Fax | 708-532-7391
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Provider Business Mailing Address
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Address Line | 10401 S CENTRAL PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60655-3111
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Country | US
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Telephone | 773-633-5354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.303980
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License Number State | IL
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