Basic Information
Provider Information
NPI: 1174575211
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNAPP
FirstName: KELLY
MiddleName: COULTER
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 88 GIBSON RD
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288041736
CountryCode: US
TelephoneNumber: 8282987911
FaxNumber: 8282995889
Practice Location
Address1: 1100 TUNNEL RD
Address2: VAMC-PHARMACY DEPARTMENT 119
City: ASHEVILLE
State: NC
PostalCode: 288052043
CountryCode: US
TelephoneNumber: 8282987911
FaxNumber: 8282995889
Other Information
ProviderEnumerationDate: 05/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P1200X09386NCY Pharmacy Service ProvidersPharmacistPharmacotherapy

No ID Information.


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