Provider Demographics
NPI:1598277923
Name:KEITH, CYNTHIA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:KEITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:P.O. BOX 1623
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258
Mailing Address - Country:US
Mailing Address - Phone:209-712-6438
Mailing Address - Fax:209-625-8195
Practice Address - Street 1:407 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571
Practice Address - Country:US
Practice Address - Phone:707-374-5135
Practice Address - Fax:707-374-5408
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist