Provider Demographics
NPI:1730408410
Name:KNODT, NICOLE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KNODT
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:PSC 704 BOX 2589
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-0006
Mailing Address - Country:US
Mailing Address - Phone:81803-690-5835
Mailing Address - Fax:
Practice Address - Street 1:BG CRAWFORD F. SAMS US ARMY HEALTH CLINIC UNIT 45011
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:406-407-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist