Basic Information
Provider Information | |||||||||
NPI: | 1144203704 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SNASHALL | ||||||||
FirstName: | WENDY | ||||||||
MiddleName: | LYNNE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 112 SMOKY CT | ||||||||
Address2: |   | ||||||||
City: | ELIZABETHTOWN | ||||||||
State: | KY | ||||||||
PostalCode: | 427016859 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2703608521 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 289 IRELAND AVE | ||||||||
Address2: |   | ||||||||
City: | FORT KNOX | ||||||||
State: | KY | ||||||||
PostalCode: | 401215111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5026240693 | ||||||||
FaxNumber: | 5026249873 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/28/2005 | ||||||||
LastUpdateDate: | 06/08/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 011163 | KY | N |   | Pharmacy Service Providers | Pharmacist |   | 1835P0018X | 011163 | KY | Y |   | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.