Healthcare Provider Details

I. General information

NPI: 1457435232
Provider Name (Legal Business Name): JOSEPH C SNYDER JR. DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN AVE
ERWIN TN
37650-1237
US

IV. Provider business mailing address

101 S MAIN AVE
ERWIN TN
37650-1237
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-4881
  • Fax: 423-743-0947
Mailing address:
  • Phone: 423-743-4881
  • Fax: 423-743-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4734
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: