Provider Demographics
NPI:1083050611
Name:KNAPP, JOHN VICTOR (JOHN KNAPP RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VICTOR
Last Name:KNAPP
Suffix:
Gender:M
Credentials:JOHN KNAPP RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 SMALLEY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49612-9710
Mailing Address - Country:US
Mailing Address - Phone:231-649-0485
Mailing Address - Fax:
Practice Address - Street 1:619 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-9766
Practice Address - Country:US
Practice Address - Phone:231-587-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist