Provider Demographics
NPI:1275742678
Name:KNEPPER, EDGAR LEE (RPH)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:LEE
Last Name:KNEPPER
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 1:72677 690TH ST
Mailing Address - Street 2:PO BOX 190
Mailing Address - City:CUMBERLAND
Mailing Address - State:IA
Mailing Address - Zip Code:50843-8072
Mailing Address - Country:US
Mailing Address - Phone:712-774-2582
Mailing Address - Fax:
Practice Address - Street 1:72677 690TH ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:IA
Practice Address - Zip Code:50843-8072
Practice Address - Country:US
Practice Address - Phone:712-774-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist