Healthcare Provider Details

I. General information

NPI: 1356939698
Provider Name (Legal Business Name): DAVID JACOB SNYDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BOSTON POST RD
WESTON MA
02493-2525
US

IV. Provider business mailing address

821 CENTRE ST APT 3
JAMAICA PLAIN MA
02130-2748
US

V. Phone/Fax

Practice location:
  • Phone: 860-305-8542
  • Fax: 866-422-7165
Mailing address:
  • Phone: 860-305-8542
  • Fax: 866-422-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0012694
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH235461
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH235461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: