Provider Demographics
NPI:1841828340
Name:KNOKE, AMY JANE (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:KNOKE
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 1:1715 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7577
Mailing Address - Country:US
Mailing Address - Phone:563-419-0535
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7497
Practice Address - Country:US
Practice Address - Phone:563-382-8456
Practice Address - Fax:563-382-8654
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist