MEDICARE: KNIGHT PRESCRIPTION SERVICES

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
1	333600000X	Pharmacy	5301002041	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2332738	OTHER	MI	NCPDP
2	1295728095	OTHER	MI	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295728095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNIGHT PRESCRIPTION SERVICES

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	:	4501 WOODWARD AVE
Second Line	:	SUITE 104A
City	:	DETROIT
State	:	MI
Zip	:	48201-1890
Country	:	US
Telephone Number	:	313-832-5800
Fax Number	:	313-832-5802

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	:	08/02/2013

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Directions to “KNIGHT PRESCRIPTION SERVICES ” Practice Location

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