Provider Demographics
NPI:1245611292
Name:SNYDER, ALISA NICHOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:NICHOLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALISA
Other - Middle Name:NICHOLE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-0724
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5111
Practice Address - Country:US
Practice Address - Phone:253-968-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist