Provider Demographics
NPI:1669829479
Name:ZELL, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ZELL
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 1:8432 GENTIAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5028
Mailing Address - Country:US
Mailing Address - Phone:817-914-4029
Mailing Address - Fax:
Practice Address - Street 1:7800 SUMMER CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2093
Practice Address - Country:US
Practice Address - Phone:682-312-1993
Practice Address - Fax:682-312-1992
Is Sole Proprietor?:No
Enumeration Date:2016-05-22
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25778183500000X
TX54616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist