MEDICARE: KNIGHT PHARMACIES, 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
1	333600000X	Pharmacy	5301004774	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2343426	OTHER	MI	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1710970504	OTHER	MI	NPI

General Provider Information

NPI Number	:	1710970504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNIGHT PHARMACIES, 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	:	4059 W DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3262
Country	:	US
Telephone Number	:	313-933-6740
Fax Number	:	313-933-6741

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	:	10/28/2010

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