OrganizationActive
Knightdale Family Practice
NPI 1689804403 · Non-Pharmacy Dispensing Site · Knightdale, NC
Provider details
- NPI number
- 1689804403
- Entity type
- Organization
- Primary specialty
- Non-Pharmacy Dispensing SiteSuppliers
- Parent organization
- Medvantx, Inc.
- Organization subpart
- Yes
- Authorized official
- Kenny Heine, Director of Operations(858) 625-2990
- License
- 9401111 (NC)
Specialties & taxonomies
Suppliers
Practice location
6905 Knightdale Blvd
Suite 106
Knightdale, NC 27545-6505
Phone: (919) 266-6211
Approximate (ZIP-level) locationGet directions
Mailing address
5810 Nancy Ridge Dr
San Diego, CA 92121-2834
Registry dates
- Enumerated
- 2009-07-15
- Last updated
- 2009-07-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.