Provider Demographics
NPI:1740879063
Name:KNIGHT, TODD MITCHELL
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MITCHELL
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TENNYSON PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1525
Mailing Address - Country:US
Mailing Address - Phone:609-602-8042
Mailing Address - Fax:
Practice Address - Street 1:401 S PITNEY RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9780
Practice Address - Country:US
Practice Address - Phone:609-404-4161
Practice Address - Fax:609-404-4190
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01698400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist