Provider Demographics
NPI:1336299197
Name:KNIGHT, KENNETH ELMORE (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ELMORE
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 1:851 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-2777
Mailing Address - Country:US
Mailing Address - Phone:334-636-5270
Mailing Address - Fax:334-636-5144
Practice Address - Street 1:34301 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3341
Practice Address - Country:US
Practice Address - Phone:334-636-5448
Practice Address - Fax:334-636-5144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist