Provider Demographics
NPI:1427658012
Name:LINES, CYNTHIA ANN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:LINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 KITCHEN RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-8773
Mailing Address - Country:US
Mailing Address - Phone:814-771-3748
Mailing Address - Fax:
Practice Address - Street 1:313 KITCHEN RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-8773
Practice Address - Country:US
Practice Address - Phone:814-771-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033632L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP033632LOtherPA BOARD OF PHARMACY
PARPI009392OtherPA BOARD OF PHARMACY