=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386052728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYAN SNYDER PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 04/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5454 CROSSINGS DR
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-783-8052
-----------------------------------------------------
Fax | 916-783-8066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5454 CROSSINGS DR
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-783-8052
-----------------------------------------------------
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 | 65727
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------