Provider Demographics
NPI:1306351606
Name:KNESS, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KNESS
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 1:1609 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4405
Mailing Address - Country:US
Mailing Address - Phone:919-395-4679
Mailing Address - Fax:
Practice Address - Street 1:1985 UMSTEAD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2035
Practice Address - Country:US
Practice Address - Phone:919-855-4300
Practice Address - Fax:919-715-1255
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12283OtherPHARMACIST LICENSE