Provider Demographics
NPI:1285918953
Name:SMART, CYNTHIA LEE (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:SMART
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 IONOSPHERE ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8416
Mailing Address - Country:US
Mailing Address - Phone:720-384-7217
Mailing Address - Fax:
Practice Address - Street 1:1940 IONOSPHERE ST UNIT 5
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8416
Practice Address - Country:US
Practice Address - Phone:720-384-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist