Healthcare Provider Details

I. General information

NPI: 1568731040
Provider Name (Legal Business Name): CHARLES CLAYTON SNYDER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEYSER AVE
NATCHITOCHES LA
71457-6018
US

IV. Provider business mailing address

717 SAINT CLAIR AVE
NATCHITOCHES LA
71457-6132
US

V. Phone/Fax

Practice location:
  • Phone: 318-214-5760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019231
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: