Healthcare Provider Details

I. General information

NPI: 1295498020
Provider Name (Legal Business Name): ASHLEY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E WASHINGTON ST
MT PLEASANT IA
52641-3210
US

IV. Provider business mailing address

423 QUINCY RD
CARTHAGE IL
62321-1605
US

V. Phone/Fax

Practice location:
  • Phone: 319-986-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24110
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: