Provider Demographics
NPI:1437226966
Name:KNICK, MICHAEL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:KNICK
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 1:1301 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9146
Mailing Address - Country:US
Mailing Address - Phone:540-332-8552
Mailing Address - Fax:
Practice Address - Street 1:1301 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9146
Practice Address - Country:US
Practice Address - Phone:540-332-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist