Provider Demographics
NPI:1427327600
Name:KOVACH, CYNTHIA MARIE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:KOVACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3137
Mailing Address - Country:US
Mailing Address - Phone:239-656-1424
Mailing Address - Fax:239-543-5704
Practice Address - Street 1:6370 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3137
Practice Address - Country:US
Practice Address - Phone:239-656-1424
Practice Address - Fax:239-543-5704
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40519183500000X
VA02002205737183500000X
WVRP0006503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist