Provider Demographics
NPI:1285627026
Name:KNIGHT DRUGS EAST SEVEN MILE, INC.
Entity Type:Organization
Organization Name:KNIGHT DRUGS EAST SEVEN MILE, INC.
Other - Org Name:KNIGHT DRUGS CDP#1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VESTICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-921-0154
Mailing Address - Street 1:7900 KERCHEVAL ST
Mailing Address - Street 2:#131
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2439
Mailing Address - Country:US
Mailing Address - Phone:313-921-0154
Mailing Address - Fax:313-921-0185
Practice Address - Street 1:7900 KERCHEVAL ST
Practice Address - Street 2:#131
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2439
Practice Address - Country:US
Practice Address - Phone:313-921-0154
Practice Address - Fax:313-921-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53011007206333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2361486OtherNCPDP
MI2361486Medicaid
MI2361486Medicaid