Provider Demographics
NPI:1710295035
Name:PAGE, CYNTHIA G (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:G
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-5209
Mailing Address - Country:US
Mailing Address - Phone:318-525-0144
Mailing Address - Fax:318-525-0222
Practice Address - Street 1:3555 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-5209
Practice Address - Country:US
Practice Address - Phone:318-525-0144
Practice Address - Fax:318-525-0222
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist