Provider Demographics
NPI:1124378674
Name:KNOPP, DAVID LLOYD (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LLOYD
Last Name:KNOPP
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 1:33644 YUCAIPA BLVD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2071
Mailing Address - Country:US
Mailing Address - Phone:909-790-1961
Mailing Address - Fax:909-797-9526
Practice Address - Street 1:33644 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2071
Practice Address - Country:US
Practice Address - Phone:909-790-1961
Practice Address - Fax:909-797-9526
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist