Provider Demographics
NPI:1144503780
Name:KNAPP, BLAKE EDWARD (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:EDWARD
Last Name:KNAPP
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3248
Mailing Address - Country:US
Mailing Address - Phone:618-533-5395
Mailing Address - Fax:618-533-5506
Practice Address - Street 1:225 N ELM ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3248
Practice Address - Country:US
Practice Address - Phone:618-533-5395
Practice Address - Fax:618-533-5506
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist