Provider Demographics
NPI:1154388320
Name:SNELLENBERGER, LAURA (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SNELLENBERGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:VASSAR
Mailing Address - State:MI
Mailing Address - Zip Code:48768-9611
Mailing Address - Country:US
Mailing Address - Phone:989-823-2945
Mailing Address - Fax:
Practice Address - Street 1:1008 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MI
Practice Address - Zip Code:48655-1022
Practice Address - Country:US
Practice Address - Phone:989-865-9971
Practice Address - Fax:989-865-6216
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist