Provider Demographics
NPI:1487721270
Name:KNISHKA, SCOTT PETER (RPH, BCNP)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PETER
Last Name:KNISHKA
Suffix:
Gender:M
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 LEXINGTON DR
Mailing Address - Street 2:COMPLIANCE MAIL CODE 2433
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2102
Mailing Address - Country:US
Mailing Address - Phone:608-263-0359
Mailing Address - Fax:608-265-7390
Practice Address - Street 1:600 HIGHLAND AVE CSC E1 # 382C
Practice Address - Street 2:COMPLIANCE MAIL CODE 2433
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12749-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12749-040OtherPHARMACIST