Provider Demographics
NPI:1144555780
Name:FETZNER, CYNTHIA ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:FETZNER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 KINGSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6949
Mailing Address - Country:US
Mailing Address - Phone:910-410-3710
Mailing Address - Fax:910-410-9041
Practice Address - Street 1:185 KINGSWOOD CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-410-3710
Practice Address - Fax:910-410-9041
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0775363Medicaid