Healthcare Provider Details

I. General information

NPI: 1538209432
Provider Name (Legal Business Name): DAVID CARL SNODGRASS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N EDDY ST
SOUTH BEND IN
46617-2808
US

IV. Provider business mailing address

51887 FOXDALE LN
GRANGER IN
46530-8883
US

V. Phone/Fax

Practice location:
  • Phone: 574-237-9295
  • Fax: 574-239-1554
Mailing address:
  • Phone: 574-243-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016408A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: