MEDICARE: TIMOTHY KNAPP

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	026441	MI

General Provider Information

NPI Number	:	1568993095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY KNAPP

Provider Business Mailing Address
First Line	:	7275 HURON AVE
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-8324
Country	:	US
Telephone Number	:	810-359-5322
Fax Number	:	810-359-7200

Provider Business Practice Location Address
First Line	:	7275 HURON AVE
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-8324
Country	:	US
Telephone Number	:	810-359-5322
Fax Number	:	810-359-7200

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

Provider Enumeration Date	:	03/26/2017
Last Update Date	:	03/26/2017

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Directions to “ TIMOTHY KNAPP ” Practice Location

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