Provider Demographics
NPI:1992072045
Name:KNOBLOCH, STEVEN RICHARD (PHARM D)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:KNOBLOCH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N65W25055 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2671
Mailing Address - Country:US
Mailing Address - Phone:262-820-0750
Mailing Address - Fax:
Practice Address - Street 1:N65W25055 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2671
Practice Address - Country:US
Practice Address - Phone:262-820-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14875-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist