Provider Demographics
NPI:1285159152
Name:KNIPPERX INC.
Entity type:Organization
Organization Name:KNIPPERX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, VP, SEC., TREASURER AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-905-7878
Mailing Address - Street 1:1 HEALTHCARE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5400
Mailing Address - Country:US
Mailing Address - Phone:732-905-7878
Mailing Address - Fax:732-886-9205
Practice Address - Street 1:1250 PATROL RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8670
Practice Address - Country:US
Practice Address - Phone:855-647-7379
Practice Address - Fax:855-774-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006622A333600000X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007059Medicaid