Provider Demographics
NPI:1205944386
Name:SNYDERS PHARMACY
Entity type:Organization
Organization Name:SNYDERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-684-3400
Mailing Address - Street 1:122 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120
Mailing Address - Country:US
Mailing Address - Phone:269-684-3400
Mailing Address - Fax:269-684-1221
Practice Address - Street 1:122 GRANT STREET
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120
Practice Address - Country:US
Practice Address - Phone:269-684-3400
Practice Address - Fax:269-684-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301002439333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2308749Medicaid
2308749OtherNABP
0934110001Medicare ID - Type Unspecified