Provider Demographics
NPI:1760649313
Name:KNAPP, TRACEY LEA (RPH)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEA
Last Name:KNAPP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 COYKENDALL RD
Mailing Address - Street 2:
Mailing Address - City:HIMROD
Mailing Address - State:NY
Mailing Address - Zip Code:14842-9707
Mailing Address - Country:US
Mailing Address - Phone:607-243-5881
Mailing Address - Fax:
Practice Address - Street 1:14 WATER ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:NY
Practice Address - Zip Code:14837-1028
Practice Address - Country:US
Practice Address - Phone:607-243-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist