Healthcare Provider Details

I. General information

NPI: 1710372081
Provider Name (Legal Business Name): KELLY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 W 151ST ST
OVERLAND PARK KS
66223-2113
US

IV. Provider business mailing address

8101 W 151ST ST
OVERLAND PARK KS
66223-2113
US

V. Phone/Fax

Practice location:
  • Phone: 913-905-0420
  • Fax: 913-850-6586
Mailing address:
  • Phone: 913-905-0420
  • Fax: 913-850-6586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1410730
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: