Healthcare Provider Details

I. General information

NPI: 1225042617
Provider Name (Legal Business Name): MR. MARC SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E END BLVD
WILKES BARRE PA
18711-0030
US

IV. Provider business mailing address

216 MELROSE AVE
CLARKS SUMMIT PA
18411-1440
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-3521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036888L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: