Provider Demographics
NPI:1124729074
Name:SNODGRASS, KENNETH EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 MILL HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-1328
Mailing Address - Country:US
Mailing Address - Phone:484-437-1011
Mailing Address - Fax:
Practice Address - Street 1:15 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1549
Practice Address - Country:US
Practice Address - Phone:302-737-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043158L183500000X
DEA1-0004096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist