Healthcare Provider Details

I. General information

NPI: 1861872863
Provider Name (Legal Business Name): GREGORY SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 STONEGATE DR SUITE 100
ALLENTOWN PA
18106-9297
US

IV. Provider business mailing address

937 N SAINT LUCAS ST
ALLENTOWN PA
18104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 610-794-5380
  • Fax:
Mailing address:
  • Phone: 610-509-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031346L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: