Provider Demographics
NPI:1134418072
Name:SNELL, MARY M (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:SNELL
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 1:3010 NEWLAND RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572-3114
Mailing Address - Country:US
Mailing Address - Phone:804-333-4019
Mailing Address - Fax:
Practice Address - Street 1:17422 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435
Practice Address - Country:US
Practice Address - Phone:804-529-6230
Practice Address - Fax:804-529-5267
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist