Provider Demographics
NPI:1780106633
Name:KNUTESON, DANIEL R (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:KNUTESON
Suffix:
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 1:4502 OAK SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1712
Mailing Address - Country:US
Mailing Address - Phone:608-846-4899
Mailing Address - Fax:
Practice Address - Street 1:4502 OAK SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1712
Practice Address - Country:US
Practice Address - Phone:608-846-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist