Provider Demographics
NPI:1558654228
Name:STOREY, CYNTHIA HOOVER
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:HOOVER
Last Name:STOREY
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 1:10205 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:BAHAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27503-9629
Mailing Address - Country:US
Mailing Address - Phone:919-815-1303
Mailing Address - Fax:252-431-0389
Practice Address - Street 1:109 DABNEY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4907
Practice Address - Country:US
Practice Address - Phone:252-438-2337
Practice Address - Fax:252-431-0389
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07357183500000X
VA0202006139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist