Provider Demographics
NPI:1699005702
Name:SNIJDER, ROBERT R (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SNIJDER
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 1:335 W APPLEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-9306
Mailing Address - Country:US
Mailing Address - Phone:208-765-1254
Mailing Address - Fax:208-765-1303
Practice Address - Street 1:335 W APPLEWAY AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9306
Practice Address - Country:US
Practice Address - Phone:208-765-1254
Practice Address - Fax:208-765-1303
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5750183500000X
WAPH00069808183500000X
AZ11697183500000X
MT6611183500000X
NV13687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5750OtherPHARMACIST LICENSE
WAPH00069808OtherPHARMACIST LICENSE