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General NPI Number Information
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NPI Number | 1205435682
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Entity Type | Individual
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Provider Name | KIMBERLY J SNOW
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Gender | Female
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Dates
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Enumeration Date | 10/18/2020
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Last Update Date | 10/18/2020
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Provider Practice Location Address
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Address Line | 201 MATTES AVE
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City | VANDALIA
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State | IL
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Zip | 62471-2063
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Country | US
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Telephone | 618-283-0440
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Fax | 618-283-9496
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Provider Business Mailing Address
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Address Line | 103 QUAIL HOLLOW RD
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City | GREENVILLE
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State | IL
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Zip | 62246-2786
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Country | US
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Telephone | 618-558-2864
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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 | 051.289509
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License Number State | IL
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