Provider Demographics
NPI:1952880668
Name:KNOTT, SHELBY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:KNOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1102
Mailing Address - Country:US
Mailing Address - Phone:218-745-5481
Mailing Address - Fax:
Practice Address - Street 1:103 W JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1102
Practice Address - Country:US
Practice Address - Phone:218-745-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist