Provider Demographics
NPI:1861721805
Name:KNOBLOCH, JOSEPH WAYNE
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WAYNE
Last Name:KNOBLOCH
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 1:1000 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3370
Mailing Address - Country:US
Mailing Address - Phone:936-634-7083
Mailing Address - Fax:
Practice Address - Street 1:1000 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3370
Practice Address - Country:US
Practice Address - Phone:936-634-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist