Provider Demographics
NPI:1174512545
Name:G.KNIGHT INC DBA SHOALS PHARMACY
Entity type:Organization
Organization Name:G.KNIGHT INC DBA SHOALS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, R PH
Authorized Official - Phone:256-389-9800
Mailing Address - Street 1:1404 E AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1773
Mailing Address - Country:US
Mailing Address - Phone:256-389-9800
Mailing Address - Fax:256-389-1594
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-389-9800
Practice Address - Fax:256-389-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112554333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129090Medicare UPIN
AL5690110001Medicare NSC