Provider Demographics
NPI:1285924738
Name:SHULL, CYNTHIA A (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:SHULL
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 1:34 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1814
Mailing Address - Country:US
Mailing Address - Phone:303-518-4898
Mailing Address - Fax:
Practice Address - Street 1:338 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1024
Practice Address - Country:US
Practice Address - Phone:607-776-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15151183500000X
NY052114183500000X
AK1757183500000X
NHR1616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist