Provider Demographics
NPI:1477666808
Name:SNIDER, JOHN ERIC (DPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMINY
Mailing Address - State:OK
Mailing Address - Zip Code:74035-1032
Mailing Address - Country:US
Mailing Address - Phone:918-885-2715
Mailing Address - Fax:918-885-4516
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMINY
Practice Address - State:OK
Practice Address - Zip Code:74035-1032
Practice Address - Country:US
Practice Address - Phone:918-885-2715
Practice Address - Fax:918-885-4516
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist