Healthcare Provider Details

I. General information

NPI: 1417146028
Provider Name (Legal Business Name): SPENCER SNYDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3583 W 9800 S STE 101
SOUTH JORDAN UT
84095-3254
US

IV. Provider business mailing address

11046 S MANITOU WAY
SOUTH JORDAN UT
84009-7722
US

V. Phone/Fax

Practice location:
  • Phone: 385-415-5863
  • Fax: 385-256-9431
Mailing address:
  • Phone: 801-661-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6103002-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: