Provider Demographics
NPI:1710357439
Name:KNIGHT, MARK ALAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 FILER AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4008
Mailing Address - Country:US
Mailing Address - Phone:208-733-9242
Mailing Address - Fax:208-733-2810
Practice Address - Street 1:615 FILER AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4008
Practice Address - Country:US
Practice Address - Phone:208-733-9242
Practice Address - Fax:208-733-2810
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist