Healthcare Provider Details

I. General information

NPI: 1275884488
Provider Name (Legal Business Name): SCOTT SNYDER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 NE HALBROOK LN
ANKENY IA
50023-9716
US

IV. Provider business mailing address

6902 NE HALBROOK LN
ANKENY IA
50023-9716
US

V. Phone/Fax

Practice location:
  • Phone: 515-289-1964
  • Fax:
Mailing address:
  • Phone: 515-289-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17973
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: