Provider Demographics
NPI:1952338329
Name:KNIGHTEN, VIRGINIA R (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:R
Last Name:KNIGHTEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5640
Mailing Address - Country:US
Mailing Address - Phone:850-913-9300
Mailing Address - Fax:
Practice Address - Street 1:101 VERNON AVE
Practice Address - Street 2:STE 387
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7018
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:850-636-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist