Provider Demographics
NPI:1417650904
Name:HURLOCK, CYNTHIA D
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:HURLOCK
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 1:32518 223RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-1313
Mailing Address - Country:US
Mailing Address - Phone:360-886-3227
Mailing Address - Fax:
Practice Address - Street 1:20518 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1542
Practice Address - Country:US
Practice Address - Phone:253-854-2999
Practice Address - Fax:253-850-7631
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00022561183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician