Healthcare Provider Details

I. General information

NPI: 1356301303
Provider Name (Legal Business Name): JEFFREY ALAN SNYDER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

113 NANTUCKET CIR
VACAVILLE CA
95687-4124
US

V. Phone/Fax

Practice location:
  • Phone: 707-723-7121
  • Fax: 707-723-7994
Mailing address:
  • Phone: 707-689-5206
  • Fax: 707-723-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-14904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: