Healthcare Provider Details

I. General information

NPI: 1144314543
Provider Name (Legal Business Name): SNYDERS DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 HIGHWAY 88
ST ANTHONY MN
55418-3266
US

IV. Provider business mailing address

14525 HIGHWAY 7
MINNETONKA MN
55345-3734
US

V. Phone/Fax

Practice location:
  • Phone: 612-781-4800
  • Fax: 612-788-1337
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2617970
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JODI RISTAU
Title or Position: DIRECTOR
Credential:
Phone: 952-936-2404