Provider Demographics
NPI:1043243918
Name:KNUTSEN, CARL V (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:V
Last Name:KNUTSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 CLOVERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4165
Mailing Address - Country:US
Mailing Address - Phone:630-355-4015
Mailing Address - Fax:312-666-9220
Practice Address - Street 1:2003 W FULTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2365
Practice Address - Country:US
Practice Address - Phone:312-222-8020
Practice Address - Fax:312-666-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist