Provider Demographics
NPI:1912124512
Name:KNABE, ROBERT H JR (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:KNABE
Suffix:JR
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 1:370 CHERRYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6890
Mailing Address - Country:US
Mailing Address - Phone:269-323-4213
Mailing Address - Fax:
Practice Address - Street 1:1434 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-1928
Practice Address - Country:US
Practice Address - Phone:269-965-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032867OtherPHARMACIST LICENSE NUMBER