Provider Demographics
NPI:1316560204
Name:DANIEL KNIGHT
Entity Type:Organization
Organization Name:DANIEL KNIGHT
Other - Org Name:ALCHEMY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:855-277-5901
Mailing Address - Street 1:419 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-2448
Mailing Address - Country:US
Mailing Address - Phone:855-277-5901
Mailing Address - Fax:949-577-4681
Practice Address - Street 1:112 W. PARK AVE
Practice Address - Street 2:
Practice Address - City:ASH FORK
Practice Address - State:AZ
Practice Address - Zip Code:86320-8632
Practice Address - Country:US
Practice Address - Phone:855-277-5901
Practice Address - Fax:949-577-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12194711OtherCAQH
AZ943317Medicaid