Provider Demographics
NPI:1053466078
Name:SNYDER PHARMACY INC
Entity Type:Organization
Organization Name:SNYDER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:716-839-3050
Mailing Address - Street 1:4536 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3828
Mailing Address - Country:US
Mailing Address - Phone:716-839-3050
Mailing Address - Fax:716-839-1140
Practice Address - Street 1:4536 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3828
Practice Address - Country:US
Practice Address - Phone:716-839-3050
Practice Address - Fax:716-839-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0080503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01328665Medicaid
3300895OtherNABP
NY0162510001Medicare NSC