Healthcare Provider Details

I. General information

NPI: 1891402756
Provider Name (Legal Business Name): JONATHAN PAUL SNYDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 E CHANDLER HEIGHTS RD
GILBERT AZ
85298-4261
US

IV. Provider business mailing address

4378 E AUSTIN LN
SAN TAN VALLEY AZ
85140-4389
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-4894
  • Fax:
Mailing address:
  • Phone: 480-204-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: