Provider Demographics
NPI:1962738294
Name:MACIAK, CYNTHIA (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MACIAK
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 1:3205 W CORTARO FARMS RD
Mailing Address - Street 2:UNIT 28
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-1200
Mailing Address - Country:US
Mailing Address - Phone:314-420-2415
Mailing Address - Fax:
Practice Address - Street 1:240 W CONTINENTAL RD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-625-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045173183500000X
AZS019700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist