Provider Demographics
NPI:1659670859
Name:HUGULEY, CYNTHIA JOHNSON
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JOHNSON
Last Name:HUGULEY
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 1:3028 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1252
Mailing Address - Country:US
Mailing Address - Phone:770-971-6180
Mailing Address - Fax:
Practice Address - Street 1:3028 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1252
Practice Address - Country:US
Practice Address - Phone:770-971-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist