Provider Demographics
NPI:1992741680
Name:KNIGHT, MARTIN ALEXANDER JR
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ALEXANDER
Last Name:KNIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10508 JUNEAU WAY
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1970
Mailing Address - Country:US
Mailing Address - Phone:901-853-7424
Mailing Address - Fax:
Practice Address - Street 1:10508 JUNEAU WAY
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1970
Practice Address - Country:US
Practice Address - Phone:901-853-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1101-0132-5393-524183700000X
CAEXC 16844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No183500000XPharmacy Service ProvidersPharmacist