Healthcare Provider Details

I. General information

NPI: 1598175325
Provider Name (Legal Business Name): MARIE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

1030 JEFFERSON AVE
MEMPHIS TN
38104-2127
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-523-7333
Mailing address:
  • Phone: 901-523-8990
  • Fax: 901-523-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202210812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: