Provider Demographics
NPI:1215201090
Name:KNAPP NUTRITIONAL & PHARMACY INC
Entity Type:Organization
Organization Name:KNAPP NUTRITIONAL & PHARMACY INC
Other - Org Name:KNAPP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABATAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-6178
Mailing Address - Street 1:2310 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5924
Mailing Address - Country:US
Mailing Address - Phone:718-513-6178
Mailing Address - Fax:718-513-6179
Practice Address - Street 1:2310 KNAPP ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5924
Practice Address - Country:US
Practice Address - Phone:718-513-6178
Practice Address - Fax:718-513-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0312353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135257OtherPK