Provider Demographics
NPI:1528382371
Name:KIGHT, CHARLES EDWARD (PD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:KIGHT
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17340 QUAKER LANE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1247
Mailing Address - Country:US
Mailing Address - Phone:301-774-2201
Mailing Address - Fax:301-774-2202
Practice Address - Street 1:17340 QUAKER LANE
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1247
Practice Address - Country:US
Practice Address - Phone:301-774-2201
Practice Address - Fax:301-774-2202
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07389183500000X
PA23250255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist