Provider Demographics
NPI:1891072716
Name:KNOTT, ROBERT J (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KNOTT
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 1:3425 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3404
Mailing Address - Country:US
Mailing Address - Phone:563-332-6049
Mailing Address - Fax:563-332-6162
Practice Address - Street 1:3425 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3404
Practice Address - Country:US
Practice Address - Phone:563-332-6049
Practice Address - Fax:563-332-6162
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA16145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist