Provider Demographics
NPI:1558774851
Name:KNOCKLEIN, LINETTE
Entity Type:Individual
Prefix:
First Name:LINETTE
Middle Name:
Last Name:KNOCKLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 LAYDEN COVE WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1750
Mailing Address - Country:US
Mailing Address - Phone:757-481-0237
Mailing Address - Fax:
Practice Address - Street 1:1517 LAYDEN COVE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1750
Practice Address - Country:US
Practice Address - Phone:757-481-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist