Provider Demographics
NPI:1770676934
Name:KNOTT PRESCRIPTION CENTER, INC.
Entity Type:Organization
Organization Name:KNOTT PRESCRIPTION CENTER, INC.
Other - Org Name:KNOTT PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES AND PHRMCST IN CHRG
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-785-0889
Mailing Address - Street 1:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-1042
Mailing Address - Country:US
Mailing Address - Phone:606-785-0889
Mailing Address - Fax:
Practice Address - Street 1:59 WEST HWY 80, SUITE 1
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-0889
Practice Address - Fax:606-785-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP070643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034338OtherPK
KY5401100200Medicaid