Healthcare Provider Details

I. General information

NPI: 1205944386
Provider Name (Legal Business Name): SNYDERS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GRANT STREET
NILES MI
49120
US

IV. Provider business mailing address

122 GRANT STREET
NILES MI
49120
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-3400
  • Fax: 269-684-1221
Mailing address:
  • Phone: 269-684-3400
  • Fax: 269-684-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301002439
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES A SNYDER
Title or Position: RPH OWNER
Credential: RPH
Phone: 269-684-3400