=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356691810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA C BALDASSNO-SNISCAK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2012
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7301 RADIO RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34104-6709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-353-2484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4557 EAGLE KEY CIR
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34112-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-821-3029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP037275L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------