Provider Demographics
NPI:1972972206
Name:KNIFFEN, GREGORY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:KNIFFEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S GREELEY HWY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2848
Mailing Address - Country:US
Mailing Address - Phone:303-635-4087
Mailing Address - Fax:
Practice Address - Street 1:700 S GREELEY HWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2848
Practice Address - Country:US
Practice Address - Phone:303-635-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist