Provider Demographics
NPI:1255602728
Name:KNOBEL, BRYAN JOHN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOHN
Last Name:KNOBEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 NE 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3028
Mailing Address - Country:US
Mailing Address - Phone:360-993-1107
Mailing Address - Fax:
Practice Address - Street 1:6708 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1915
Practice Address - Country:US
Practice Address - Phone:360-696-0750
Practice Address - Fax:360-567-1679
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00019906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist