Provider Demographics
NPI:1417510645
Name:KERR, CYNTHIA LYN (BPHARM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYN
Last Name:KERR
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7577 W CABALLO CV
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1235
Mailing Address - Country:US
Mailing Address - Phone:801-455-7663
Mailing Address - Fax:
Practice Address - Street 1:2255 N UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1588
Practice Address - Country:US
Practice Address - Phone:385-219-3077
Practice Address - Fax:385-219-3071
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274699-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist