Provider Demographics
NPI:1619227980
Name:CARLSON, CYNTHIA E (XTS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:F
Credentials:XTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4719
Mailing Address - Country:US
Mailing Address - Phone:843-785-7786
Mailing Address - Fax:843-785-8963
Practice Address - Street 1:10 POPE AVE
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928
Practice Address - Country:US
Practice Address - Phone:843-785-7786
Practice Address - Fax:843-785-8963
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist