Healthcare Provider Details

I. General information

NPI: 1790389054
Provider Name (Legal Business Name): SPENCER SNYDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 BLUFFTON RD
FORT WAYNE IN
46809-2706
US

IV. Provider business mailing address

7008 BLUFFTON RD
FORT WAYNE IN
46809-2706
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-4136
  • Fax: 260-747-4137
Mailing address:
  • Phone: 260-747-4136
  • Fax: 260-747-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028351A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: