Provider Demographics
NPI:1023445376
Name:SNYDER, JENISE JANE (RPH)
Entity type:Individual
Prefix:
First Name:JENISE
Middle Name:JANE
Last Name:SNYDER
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 1:801 CONGRESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-818-1059
Mailing Address - Fax:317-818-1094
Practice Address - Street 1:801 CONGRESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5646
Practice Address - Country:US
Practice Address - Phone:317-818-1059
Practice Address - Fax:317-818-1094
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017348A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist