Provider Demographics
NPI:1316211204
Name:KNIGHT, JENNIFER GWYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GWYNN
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 LAKELINE MALL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5924
Mailing Address - Country:US
Mailing Address - Phone:512-651-3377
Mailing Address - Fax:
Practice Address - Street 1:10900 LAKELINE MALL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5924
Practice Address - Country:US
Practice Address - Phone:512-651-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist