Provider Demographics
NPI:1023393725
Name:KNIGHT, RANDALL (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4141
Mailing Address - Country:US
Mailing Address - Phone:909-793-6957
Mailing Address - Fax:
Practice Address - Street 1:1634 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4616
Practice Address - Country:US
Practice Address - Phone:909-882-2836
Practice Address - Fax:909-882-9015
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist