Healthcare Provider Details

I. General information

NPI: 1245611292
Provider Name (Legal Business Name): ALISA NICHOLE SNYDER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISA NICHOLE FISHER PHARMD

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-5111
US

IV. Provider business mailing address

289 IRELAND AVE
FORT KNOX KY
40121-5111
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3427
  • Fax:
Mailing address:
  • Phone: 502-624-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP446772
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: