Provider Demographics
NPI:1922693241
Name:KNOX, THEA D (RPH)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:D
Last Name:KNOX
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 1:18715 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MO
Mailing Address - Zip Code:64098-9110
Mailing Address - Country:US
Mailing Address - Phone:816-786-8621
Mailing Address - Fax:
Practice Address - Street 1:1025 N 3RD ST STE 110
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1445
Practice Address - Country:US
Practice Address - Phone:785-331-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043798183500000X
KS111958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist