Provider Demographics
NPI:1659395804
Name:FISHER, CYNTHIA KAY BULLINGTON (DPH)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA KAY
Middle Name:BULLINGTON
Last Name:FISHER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SUMMER HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3790
Mailing Address - Country:US
Mailing Address - Phone:423-658-5434
Mailing Address - Fax:423-638-3311
Practice Address - Street 1:239 W SUMMER ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4925
Practice Address - Country:US
Practice Address - Phone:423-638-4711
Practice Address - Fax:423-638-3311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454403Medicaid
TN1454403Medicaid