MEDICARE: SNYDER DRUG STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	262951	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2428008	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1104978451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNYDER DRUG STORES INC

Provider Business Mailing Address
First Line	:	802 YELLOW BRICK RD
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 YELLOW BRICK RD
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2152
Country	:	US
Telephone Number	:	952-448-2737
Fax Number	:	952-936-2589

Authorized Official
Title or Position	:	DIRECTOR OF PHCY OPS
Name	:	JODI ROBINSON
Credential	:	PHARMD
Telephone Number	:	952-936-2404

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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