Provider Demographics
NPI:1003598855
Name:MORENO, CYNTHIA LEE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:MORENO
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 1:1923 S MARRS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79103-4905
Mailing Address - Country:US
Mailing Address - Phone:806-690-3387
Mailing Address - Fax:
Practice Address - Street 1:1923 S MARRS ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-4905
Practice Address - Country:US
Practice Address - Phone:806-690-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405010108955829183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician