Healthcare Provider Details

I. General information

NPI: 1689988677
Provider Name (Legal Business Name): FREDRICK MARC SNYDER RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 CRITTENDEN ST
PHILADELPHIA PA
19118-4421
US

IV. Provider business mailing address

402 REVERE DR
SOUTHAMPTON PA
18966-2762
US

V. Phone/Fax

Practice location:
  • Phone: 215-242-8022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029175L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: