Healthcare Provider Details

I. General information

NPI: 1912672072
Provider Name (Legal Business Name): JEFF SNELLEN II PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 CATLIN DR
BARNHART MO
63012-1277
US

IV. Provider business mailing address

506 BACON AVE
WEBSTER GROVES MO
63119-1513
US

V. Phone/Fax

Practice location:
  • Phone: 636-461-1347
  • Fax:
Mailing address:
  • Phone: 314-452-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021031024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: