Healthcare Provider Details

I. General information

NPI: 1265941389
Provider Name (Legal Business Name): MICHAEL SNIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13055 HIGHWAY 9 N
MILTON GA
30004-5137
US

IV. Provider business mailing address

13055 HIGHWAY 9 N
MILTON GA
30004
US

V. Phone/Fax

Practice location:
  • Phone: 770-225-1781
  • Fax:
Mailing address:
  • Phone: 770-225-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029969
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: