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General NPI Number Information
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NPI Number | 1124997853
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Entity Type | Individual
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Provider Name | BRAXTON SNUFFER
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Gender | Male
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 866-600-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 412 N DESPLAINES ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60654-5572
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Country | US
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Telephone | 231-740-3435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.307150
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License Number State | IL
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