Provider Demographics
NPI:1972887834
Name:MCDERMOTT, CYNTHIA
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4912 MOUNTAIN PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1779
Mailing Address - Country:US
Mailing Address - Phone:702-354-8049
Mailing Address - Fax:
Practice Address - Street 1:6151 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2660
Practice Address - Country:US
Practice Address - Phone:702-631-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31525183500000X
NV14408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist