Provider Demographics
NPI:1992830517
Name:SNOOK, ROGER W (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:SNOOK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ZENITH DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0282
Mailing Address - Country:US
Mailing Address - Phone:712-322-7155
Mailing Address - Fax:
Practice Address - Street 1:133 ZENITH DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0282
Practice Address - Country:US
Practice Address - Phone:712-322-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist