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NPI Code Detail

MEDICARE: KNIGHT DRUGS OWOSSO, INC.

MEDICARE: KNIGHT DRUGS OWOSSO, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy5301007542MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12363771OTHERMINCPDP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31063405801OTHERMINPI

General Provider Information

NPI Number : 1063405801
Entity Type Code : Organization
Provider Name (Legal Business Name) : KNIGHT DRUGS OWOSSO, INC.
Provider Business Mailing Address
First Line : 2520 INDUSTRIAL ROW DR
Second Line :
City : TROY
State : MI
Zip : 48084-7035
Country : US
Telephone Number : 248-540-8066
Fax Number : 248-540-0112
Provider Business Practice Location Address
First Line : 826 W KING ST
Second Line :
City : OWOSSO
State : MI
Zip : 48867-2120
Country : US
Telephone Number : 989-723-7386
Fax Number : 989-723-7396
Authorized Official
Title or Position : PRESIDENT OF OPERATIONS
Name : MR. JOHN DEJONGH
Credential :
Telephone Number : 248-540-8066
Provider Enumeration Date : 08/26/2005
Last Update Date : 02/12/2009

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1811941446 — THOMAS M TEAL MD
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1700819810 — KEVIN P BUR D.O.
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48867-2120
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Directions to “KNIGHT DRUGS OWOSSO, INC. ” Practice Location

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