Provider Demographics
NPI:1396839791
Name:SNYDERS DRUG
Entity Type:Organization
Organization Name:SNYDERS DRUG
Other - Org Name:SNYDERS DRUG STORES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:952-936-2404
Mailing Address - Street 1:14525 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 N FAXON RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MN
Practice Address - Zip Code:55368-9694
Practice Address - Country:US
Practice Address - Phone:952-467-3144
Practice Address - Fax:952-467-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2626987333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2427121OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MN2236826 00Medicaid
0340480121Medicare NSC