Provider Demographics
NPI:1912904301
Name:KNOSS, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KNOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30310 SILVER BUTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-4911
Mailing Address - Country:US
Mailing Address - Phone:305-872-9814
Mailing Address - Fax:
Practice Address - Street 1:251 KEY DEER BLVD
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-4906
Practice Address - Country:US
Practice Address - Phone:305-872-4850
Practice Address - Fax:305-872-4995
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0028603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist