Provider Demographics
NPI:1134956261
Name:KNIGHT, PAMELA DIANA RENEE
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DIANA RENEE
Last Name:KNIGHT
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 1:22057 LIGON RD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6943
Mailing Address - Country:US
Mailing Address - Phone:225-810-1340
Mailing Address - Fax:
Practice Address - Street 1:4890 BARKSDALE BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4566
Practice Address - Country:US
Practice Address - Phone:318-747-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist