Provider Demographics
NPI:1073047445
Name:SNELL, LUKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:LUCAS
Other - Middle Name:
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1920 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-7606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8408
Practice Address - Country:US
Practice Address - Phone:208-788-4970
Practice Address - Fax:208-788-5791
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist