Provider Demographics
NPI:1730474214
Name:KNEPP, JACOB BILLINGS
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:BILLINGS
Last Name:KNEPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 S KIRKWOOD RD
Mailing Address - Street 2:T-1279
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7200
Mailing Address - Country:US
Mailing Address - Phone:314-822-4865
Mailing Address - Fax:314-822-4865
Practice Address - Street 1:1042 S KIRKWOOD RD
Practice Address - Street 2:T-1279
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7200
Practice Address - Country:US
Practice Address - Phone:314-822-4865
Practice Address - Fax:314-822-4865
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist