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NPI Code Detail

MEDICARE: MR. WAYNE ALAN KNOCKE RPH

MEDICARE: MR. WAYNE ALAN KNOCKE RPH
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
1183500000XPharmacistIL

General Provider Information

NPI Number : 1639166705
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAYNE ALAN KNOCKE RPH
Provider Business Mailing Address
First Line : 968 S LAKEWOOD TER
Second Line :
City : PORT ORANGE
State : FL
Zip : 32127-4735
Country : US
Telephone Number : 386-304-3412
Fax Number :
Provider Business Practice Location Address
First Line : 551 NATIONAL HEALTH CARE DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-1495
Country : US
Telephone Number : 386-323-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 07/08/2007

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