Basic Information
| Provider Information | |||||||||
| NPI: | 1205043379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIDER | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | JEANNETTE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2393 OAKTHORPE DR | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430268111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143194321 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 452 W. 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142930649 | ||||||||
| FaxNumber: | 6142932867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-3-26779 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.