Provider Demographics
NPI:1952666562
Name:KNIFLEY, JERRY WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:WILLIAM
Last Name:KNIFLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 CAMPBELLSVILLE RD
Mailing Address - Street 2:ROAD
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9511
Mailing Address - Country:US
Mailing Address - Phone:270-384-5143
Mailing Address - Fax:270-384-2003
Practice Address - Street 1:2991 CAMPBELLSVILLE RD
Practice Address - Street 2:ROAD
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9511
Practice Address - Country:US
Practice Address - Phone:270-384-5143
Practice Address - Fax:270-384-2003
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist