Provider Demographics
NPI:1801477849
Name:SNOW, STEPHANIE ANN (RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:SNOW
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 1:748 S MEADOWS PKWY # A-157
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3861
Mailing Address - Country:US
Mailing Address - Phone:559-779-5116
Mailing Address - Fax:
Practice Address - Street 1:216 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3519
Practice Address - Country:US
Practice Address - Phone:406-488-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-71112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist