Provider Demographics
NPI:1417515172
Name:SNIDER, JANE ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANNE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9235
Mailing Address - Country:US
Mailing Address - Phone:517-648-2632
Mailing Address - Fax:
Practice Address - Street 1:18 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3600
Practice Address - Country:US
Practice Address - Phone:269-753-1440
Practice Address - Fax:269-753-1456
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2380335OtherNABP
MI1629469036OtherNPI PRIMARY WORK SITE
MI5301011019OtherPRIMARY WORK SITE STORE LICENSE
MI5302027293OtherPHARMACIST LICENSE