Provider Demographics
NPI:1356691810
Name:BALDASSNO-SNISCAK, LAURA C (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:BALDASSNO-SNISCAK
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4557 EAGLE KEY CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5204
Mailing Address - Country:US
Mailing Address - Phone:239-821-3029
Mailing Address - Fax:
Practice Address - Street 1:7301 RADIO RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6709
Practice Address - Country:US
Practice Address - Phone:239-353-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037275L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS68277OtherPHARMACIST LICENSE
PARP037275LOtherPHARMACIST LICENSE