Provider Demographics
NPI:1912205907
Name:PENDLETON, KNIKKI CHILDS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KNIKKI
Middle Name:CHILDS
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AUDUBON CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2472
Mailing Address - Country:US
Mailing Address - Phone:404-668-6876
Mailing Address - Fax:908-243-9050
Practice Address - Street 1:1401 AUDUBON CT SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2472
Practice Address - Country:US
Practice Address - Phone:404-668-6876
Practice Address - Fax:404-758-0715
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist