Basic Information
| Provider Information | |||||||||
| NPI: | 1578838041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIPES | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 HOMLISH GDNS | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287857391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034296922 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 773 RUSS AVE | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287862998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284522230 | ||||||||
| FaxNumber: | 8284529376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2012 | ||||||||
| LastUpdateDate: | 03/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 21108 | NC | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 12912 | SC | N | Pharmacy Service Providers | Pharmacist |
No ID Information.