Healthcare Provider Details

I. General information

NPI: 1689725665
Provider Name (Legal Business Name): SNYDER DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 FREMONT AVE N
MINNEAPOLIS MN
55412-1626
US

IV. Provider business mailing address

4151 FREMONT AVE N
MINNEAPOLIS MN
55412-1626
US

V. Phone/Fax

Practice location:
  • Phone: 612-522-3634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262950
License Number StateMN

VIII. Authorized Official

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