Provider Demographics
NPI:1689621930
Name:KNOFF, LISA ANN (PHARM D)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KNOFF
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S COVENANT LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3371
Mailing Address - Country:US
Mailing Address - Phone:920-954-0611
Mailing Address - Fax:
Practice Address - Street 1:10 TRI-PARK WAY
Practice Address - Street 2:C/O APPLETON VA CLINIC
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1658
Practice Address - Country:US
Practice Address - Phone:920-831-0070
Practice Address - Fax:920-831-7939
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115554-31835P1200X
WI12485-0401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy