1295728095 NPI number — KNIGHT PRESCRIPTION SERVICES

Table of content: (NPI 1295728095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295728095 NPI number — KNIGHT PRESCRIPTION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNIGHT PRESCRIPTION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295728095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 INDUSTRIAL ROW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-7035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-540-8066
Provider Business Mailing Address Fax Number:
248-540-0112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 WOODWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 104A
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-832-5800
Provider Business Practice Location Address Fax Number:
313-832-5802
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEJONGH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
248-540-8066

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  5301002041 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2332738 . This is a "NCPDP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1295728095 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2541037 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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