Provider Demographics
NPI:1528167376
Name:CARTER, CYNTHIA C (DPH)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:C
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BRYCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3605
Mailing Address - Country:US
Mailing Address - Phone:505-672-9018
Mailing Address - Fax:
Practice Address - Street 1:407 BRYCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3605
Practice Address - Country:US
Practice Address - Phone:505-672-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist