Provider Demographics
NPI:1043896400
Name:KNIGHTON, LACHELLE
Entity Type:Individual
Prefix:
First Name:LACHELLE
Middle Name:
Last Name:KNIGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROSEWALL LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5778
Mailing Address - Country:US
Mailing Address - Phone:918-329-9142
Mailing Address - Fax:
Practice Address - Street 1:17309 I 30
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2927
Practice Address - Country:US
Practice Address - Phone:501-778-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT03506183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician