Provider Demographics
NPI:1104123611
Name:KNIGHT, JENNIFER HANCOCK
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HANCOCK
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2342
Mailing Address - Country:US
Mailing Address - Phone:803-424-2510
Mailing Address - Fax:
Practice Address - Street 1:2407 BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2342
Practice Address - Country:US
Practice Address - Phone:803-424-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist