MEDICARE: MR. JEFFREY MICHAEL KNAPP R.PH. PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10670	CO
2	183500000X	Pharmacist	46743-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10670	OTHER	CO	PHARMACIST
2	46743-1	OTHER	NY	PHARMACIST

General Provider Information

NPI Number	:	1942473095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY MICHAEL KNAPP R.PH. PHARMACIST

Provider Business Mailing Address
First Line	:	396 CHURCHILL LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-2541
Country	:	US
Telephone Number	:	315-663-5901
Fax Number	:	315-329-0244

Provider Business Practice Location Address
First Line	:	106 ARTERIAL RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-1558
Country	:	US
Telephone Number	:	315-437-0699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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