Provider Demographics
NPI:1306070909
Name:KNIGHT, CARMEN M (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:KNIGHT
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 1:1926 WOODLAND LAKE PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-7210
Mailing Address - Country:US
Mailing Address - Phone:661-565-5368
Mailing Address - Fax:260-755-0552
Practice Address - Street 1:1926 WOODLAND LAKE PASS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-7210
Practice Address - Country:US
Practice Address - Phone:661-565-5368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN91225332100000X
PR2114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26023926AOtherSTATE LICENSE