Provider Demographics
NPI:1790076545
Name:KNOOP, JOHN W (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KNOOP
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 1:4721 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SHIVELY
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2654
Mailing Address - Country:US
Mailing Address - Phone:502-447-6550
Mailing Address - Fax:502-447-1184
Practice Address - Street 1:4721 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SHIVELY
Practice Address - State:KY
Practice Address - Zip Code:40216-2654
Practice Address - Country:US
Practice Address - Phone:502-447-6550
Practice Address - Fax:502-447-1184
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY07561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist