Provider Demographics
NPI:1811232150
Name:KNOCKE, DAVID JAMES (RPH MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:KNOCKE
Suffix:
Gender:M
Credentials:RPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PERTH RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2648
Mailing Address - Country:US
Mailing Address - Phone:847-462-0611
Mailing Address - Fax:847-462-0611
Practice Address - Street 1:233 PERTH RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2648
Practice Address - Country:US
Practice Address - Phone:847-462-0611
Practice Address - Fax:847-462-0611
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10359-40183500000X
IL051.292548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist