Provider Demographics
NPI:1306480959
Name:SNYDER, BRIAN HOWARD
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HOWARD
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 HIRAM RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1271
Mailing Address - Country:US
Mailing Address - Phone:610-659-8088
Mailing Address - Fax:215-228-9099
Practice Address - Street 1:1300 W LEHIGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2760
Practice Address - Country:US
Practice Address - Phone:610-659-8088
Practice Address - Fax:215-228-9099
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035488L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist