Provider Demographics
NPI:1700198025
Name:KNORR, WAYNE REED (RPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:REED
Last Name:KNORR
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 1:178 E SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3114
Mailing Address - Country:US
Mailing Address - Phone:928-776-1936
Mailing Address - Fax:928-771-1402
Practice Address - Street 1:178 E SHELDON ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3114
Practice Address - Country:US
Practice Address - Phone:928-776-1936
Practice Address - Fax:928-771-1402
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist