Healthcare Provider Details

I. General information

NPI: 1568761948
Provider Name (Legal Business Name): RANDALL G SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CANAL ST
BRATTLEBORO VT
05301-7112
US

IV. Provider business mailing address

2535 PETERS LN
NISKAYUNA NY
12309-2412
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-4204
  • Fax:
Mailing address:
  • Phone: 518-339-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0055157
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: