Provider Demographics
NPI:1538769930
Name:SMITH, CYNTHIA KINZIE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KINZIE
Last Name:SMITH
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 1:5017 W HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6703
Mailing Address - Country:US
Mailing Address - Phone:512-892-6175
Mailing Address - Fax:512-892-6425
Practice Address - Street 1:5017 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6703
Practice Address - Country:US
Practice Address - Phone:512-892-6175
Practice Address - Fax:512-892-6425
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist