Provider Demographics
NPI:1083845119
Name:SNODDERLY, ANN RAEWYN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:RAEWYN
Last Name:SNODDERLY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CLAIBORNE RD
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-8014
Mailing Address - Country:US
Mailing Address - Phone:423-562-4928
Mailing Address - Fax:423-566-4044
Practice Address - Street 1:310 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3617
Practice Address - Country:US
Practice Address - Phone:423-562-4928
Practice Address - Fax:423-566-4044
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3536986Medicaid
TN3536986Medicaid