Healthcare Provider Details

I. General information

NPI: 1104978451
Provider Name (Legal Business Name): SNYDER DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 YELLOW BRICK RD
CHASKA MN
55318-2152
US

IV. Provider business mailing address

802 YELLOW BRICK RD
CHASKA MN
55318-2152
US

V. Phone/Fax

Practice location:
  • Phone: 952-448-2737
  • Fax: 952-936-2589
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262951
License Number StateMN

VIII. Authorized Official

Name: JODI ROBINSON
Title or Position: DIRECTOR OF PHCY OPS
Credential: PHARMD
Phone: 952-936-2404