Provider Demographics
NPI:1356939698
Name:SNYDER, DAVID JACOB (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JACOB
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CENTRE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2748
Mailing Address - Country:US
Mailing Address - Phone:860-305-8542
Mailing Address - Fax:866-422-7165
Practice Address - Street 1:133 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2525
Practice Address - Country:US
Practice Address - Phone:860-305-8542
Practice Address - Fax:866-422-7165
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012694183500000X
MAPH2354611835P1300X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric