Provider Demographics
NPI:1871805473
Name:KNIPPLE, AMY M (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:KNIPPLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 TYLER ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2655
Mailing Address - Country:US
Mailing Address - Phone:613-813-6305
Mailing Address - Fax:612-813-6300
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:MAIL STOP 32-B110
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6305
Practice Address - Fax:612-813-6300
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist