Provider Demographics
NPI:1417146028
Name:SNYDER, SPENCER (PHARMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11046 S MANITOU WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7722
Mailing Address - Country:US
Mailing Address - Phone:801-661-6477
Mailing Address - Fax:
Practice Address - Street 1:3583 W 9800 S STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3254
Practice Address - Country:US
Practice Address - Phone:385-415-5863
Practice Address - Fax:385-256-9431
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6103002-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist